Safety and effectiveness of transjugular intrahepatic portosystemic shunt in hepatocellular carcinoma patients with portal hypertension: a systematic review and meta-analysis

• Published in: Clinical radiology Vol. 78; no. 3; pp. 209 - 218
• Main Authors: Chen, Z.-X., Qiu, Z.-K., Wang, G.-B., Wang, G.-S., Jiang, W.-W., Gao, F.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.03.2023
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2022.09.126

To evaluate the safety and effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) in hepatocellular carcinoma (HCC) patients with portal hypertension. Databases including PubMed, EMBASE, and Cochrane Library (in English, until 1 October 2020) were searched for eligible studies. Data were pooled by the random-effects model using the Stata 13.0 software. Heterogeneity was assessed by I2 statistic and subgroup analyses. Ten studies (all case series) meeting the inclusion criteria were enrolled, including 655 HCC patients in whom TIPS was performed. The portosystemic pressure gradient reduction was statistically significant (standardized mean difference [SMD] –2.99, 95% confidence interval [CI]: –3.51, –2.47). The technical success rate was 99.7%. The response rates of oesophagogastric variceal bleeding (OGVB) and refractory ascites were 99.5% and 88.2%, respectively. The 30-day, 90-day, and 365-day overall survival (OS) rates were 91.9%, 61.1%, and 46.3%, respectively. During follow-up, hepatic encephalopathy occurred in 29% of the patients, while TIPS dysfunction was observed in 23% of the patients. Few technique-related complications were reported, including tumour rupture (n=5), abdominal bleeding (n=8), and acute liver failure (n=2). TIPS is a safe and effective treatment in HCC patients. Portal vein tumour thrombosis (PVTT) and cavernous transformation are the major cause of procedural failure and contribute to poor survival. Searching for the presence of PVTT and cavernous transformation is essential for assessing the safety and effectiveness of TIPS in HCC patients. •TIPS is a safe and effective treatment in HCC patients with portal hypertension.•PVTT and cavernous transformation are the major cause of procedural failure.•The presence of PVTT or cavernous transformation indicates poor survival.