Transjugular intrahepatic portosystemic shunt in patients with autoimmune hepatitis-induced cirrhosis and variceal bleeding

摘要

Abstract Background and Aim An increasing number of patients with autoimmune hepatitis (AIH)-induced cirrhosis and variceal bleeding are currently referred for transjugular intrahepatic portosystemic shunt (TIPS). The aim of this study was to evaluate the safety and efficacy of TIPS in such patients, and to compare these results with data from patients with hepatitis B virus (HBV)-induced cirrhosis.Materials and Methods This retrospective study consisted of 211 patients between August 2016 and May 2021, and patients were allocated to AIH (n?=?35) and HBV (n?=?176) groups according to the etiology of the cirrhosis. The primary endpoint was mortality after TIPS use; the secondary endpoints were recurrent bleeding, overt hepatic encephalopathy (OHE), shunt dysfunction, and dynamic changes in liver function over time.Results During a median follow-up period of 27?months, 23 (10.9) patients died, 22 (10.4) experienced recurrent bleeding, 50 (23.7) experienced OHE, and 25 (11.8) developed shunt dysfunction. Compared with the HBV group, the AIH group exhibited a similar mortality risk (adjusted hazard ratio, HR 1.199; 95 confidence interval, CI 0.367–3.917; p?=?0.764), OHE (adjusted HR 1.023, 95 CI 0.483–2.167, p?=?0.954), and shunt dysfunction (adjusted HR 0.862, 95 CI 0.285–2.610, p?=?0.792); but a higher risk of recurrent bleeding (adjusted HR 2.731, 95 CI 1.112–6.708, p?=?0.028). The dynamic changes in liver function manifested an initial trend toward deterioration, and then subsequent recovery in both the AIH and HBV groups.Conclusions TIPS is a safe and effective treatment, and should be considered for those patients with AIH-induced cirrhosis and variceal bleeding.Graphical abstract