Prognostic value of hepatocyte proliferative activity after transjugular intrahepatic portosystemic shunt.
OBJECTIVE
Previous data indicated that the proliferating cell nuclear antigen-labeling index (PCNA-LI) reflects the liver functional reserve in human liver cirrhosis. The aim of the study was to evaluate the hepatocyte proliferative activity as a marker for the outcome of patients after transjugular intrahepatic portosystemic shunt (TIPS).


METHODS
Twenty-eight consecutive patients were electively treated with TIPS for recurrent variceal bleeding (n = 14), refractory ascites (n = 12), or hydrothorax (n = 2). PCNA immunostaining was analyzed on methanol-fixed, paraffin-embedded liver biopsies.


RESULTS
After TIPS, six patients died within the first 3 months, eight other patients died later, two were transplanted, and 12 were alive at the time of analysis. Early death occurred in patients with refractory ascites (5/12) and/or in Child C patients (3/6). Among the evaluated variables, there was a statistical trend for the PCNA-LI to be lower in patients who died early after TIPS than in those having long term survival (1.55% vs 2.65%, p = 0.07). After TIPS insertion, the probability of remaining alive during the first 6 months of follow-up was significantly higher in patients with a preprocedural PCNA-LI > 2.9%.


CONCLUSIONS
The PCNA-LI measured on liver biopsy before the TIPS procedure might be a pre-TIPS marker to discriminate those patients for whom TIPS is likely to be beneficial.
Delhaye
M
M
Department of Gastroenterology, Erasme Hospital, Brussels, Belgium.
Le Moine
O
O
Degraef
C
C
Devière
J
J
Galand
P
P
D000328:Adult; D000368:Aged; D001201:Ascites / Q000378:metabolism / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000378:metabolism / Q000401:mortality / Q000601:surgery; D006491:Hemothorax / Q000378:metabolism / Q000401:mortality / Q000601:surgery; D022781:Hepatocytes / Q000737:chemistry; D006801:Humans; D008107:Liver Diseases / Q000378:metabolism / Q000401:mortality* / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011379:Prognosis; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis*; D015996:Survival Rate; D016896:Treatment Outcome
D018809:Proliferating Cell Nuclear Antigen