Pre-transjugular-intrahepatic-portosystemic-shunt measurement of hepatic venous pressure gradient and its clinical application: A comparison study

BACKGROUND It is controversial whether transjugular intrahepatic portosystemic shunt(TIPS) placement can improve long-term survival.AIM To assess whether TIPS placement improves survival in patients with hepaticvenous-pressure-gradient(HVPG) ≥ 16 mm Hg, based on HVPG-related risk stratification.METHODS Consecutive variceal bleeding patients treated with endoscopic therapy + nonselective β-blockers(NSBBs) or covered TIPS placement were retrospectively enrolled between January 2013 and December 2019. HVPG measurements were performed before therapy. The primary outcome was transplant-free survival; secondary endpoints were rebleeding and overt hepatic ence-phalopathy(OHE).RESULTS A total of 184 patients were analyzed(mean age, 55.27 years ± 13.86, 107 males; 102 in the EVL+NSBB group, 82 in the covered TIPS group). Based on the HVPG-guided risk stratification, 70 patients had HVPG < 16 mm Hg, and 114 patients had HVPG ≥ 16 mm Hg. The median follow-up time of the cohort was 49.5 mo. There was no significant difference in transplant-free survival between the two treatment groups overall(hazard ratio [HR], 0.61; 95% confidence interval [CI]: 0.35-1.05; P = 0.07). In the high-HVPG tier, transplant-free survival was higher in the TIPS group(HR, 0.44; 95%CI: 0.23-0.85; P = 0.004). In the low-HVPG tier, transplantfree survival after the two treatments was similar(HR, 0.86; 95%CI: 0.33-0.23; P = 0.74). Covered TIPS placement decreased the rate of rebleeding independent of the HVPG tier(P < 0.001). The difference in OHE between the two groups was not statistically significant(P = 0.09; P = 0.48).CONCLUSION TIPS placement can effectively improve transplant-free survival when the HVPG is greater than 16 mm Hg.