Evolution of spontaneous portosystemic shunts over time and following aetiological intervention in patients with cirrhosis.

Vidal-González, Judit; Martínez, Javier; Mulay, Akhilesh; López, Marta; Baiges, Anna; Elmahdy, Ahmed; Lampichler, Katharina; Maleux, Geert; Chang, Johannes; Poncela, Marta; Low, Gavin; Ghigliazza, Gabriele; Zipprich, Alexander; Picón, Carmen; Shah, Rushabh; Llop, Elba; Darnell, Anna; Maurer, Martin H; Bonne, Lawrence; Ramón, Enrique; ... (2024). Evolution of spontaneous portosystemic shunts over time and following aetiological intervention in patients with cirrhosis. JHEP reports, 6(2) Elsevier 10.1016/j.jhepr.2023.100977

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BACKGROUND & AIMS

Spontaneous portosystemic shunts (SPSS) develop frequently in cirrhosis. Changes over time and the effect of aetiological interventions on SPSS are unknown, so we aimed to explore the effect of these variables on SPSS evolution.

METHODS

Patients with cirrhosis from the Baveno VI-SPSS cohort were selected provided a follow-up abdominal CT or MRI scan was available. Clinical and laboratory data were collected at baseline and follow-up. Imaging tests were reviewed to evaluate changes in the presence and size of SPSS (large (L)-SPSS was ≥8 mm) over time. Regarding alcohol- or HCV-related cirrhosis, two populations were defined: cured patients (abstinent from alcohol or successful HCV therapy), and non-cured patients.

RESULTS

A total of 617 patients were included. At baseline SPSS distribution was 22% L-SPSS, 30% small (S)-SPSS, and 48% without (W)-SPSS. During follow-up (median follow-up of 63 months), SPSS distribution worsened: L-SPSS 26%, S-SPSS 32%, and W-SPSS 42% (p <0.001). Patients with worse liver function during follow-up showed a simultaneous aggravation in SPSS distribution. Non-cured patients (n = 191) experienced a significant worsening in liver function, more episodes of liver decompensation and lower transplant-free survival compared to cured patients (n = 191). However, no differences were observed regarding SPSS distribution at inclusion and at follow-up, with both groups showing a trend to worsening. Total shunt diameter increased more in non-cured (52%) than in cured patients (28%). However, total shunt area (TSA) significantly increased only in non-cured patients (74 to 122 mm2, p <0.001).

CONCLUSIONS

The presence of SPSS in cirrhosis increases over time and parallels liver function deterioration. Aetiological intervention in these patients reduces liver-related complications, but SPSS persist although progression is decreased.

IMPACT AND IMPLICATIONS

There is no information regarding the evolution of spontaneous portosystemic shunts (SPSS) during the course of cirrhosis, and especially after disease regression with aetiological interventions, such as HCV treatment with direct-acting antivirals or alcohol abstinence. These results are relevant for clinicians dealing with patients with cirrhosis and portal hypertension because they have important implications for the management of cirrhosis with SPSS after disease regression. From a practical point of view, physicians should be aware that in advanced cirrhosis with portal hypertension, after aetiological intervention, SPSS mostly persist despite liver function improvement, and complications related to SPSS may still develop.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Elmahdy Soliman, Ahmed Mahmoud, Maurer, Martin, Berzigotti, Annalisa

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2589-5559

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

29 Jan 2024 16:05

Last Modified:

14 May 2024 10:44

Publisher DOI:

10.1016/j.jhepr.2023.100977

PubMed ID:

38283756

Uncontrolled Keywords:

Advanced chronic liver disease Alcohol Ascites Collateral vessels Computed tomography Hepatic encephalopathy Hepatitis C virus Magnetic resonance imaging Portal hypertension Sustained virological response

BORIS DOI:

10.48350/192219

URI:

https://boris.unibe.ch/id/eprint/192219

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