title: Transjugular intrahepatic porto-systemic shunt is a risk factor for liver dysplasia but not hepatocellular carcinoma: a retrospective study of explanted livers.
abstract: BACKGROUND
  Conflicting data exist regarding the risk for hepatocellular carcinoma after transjugular intrahepatic porto-systemic shunt (TIPS) insertion in cirrhotic patients.
  
  
  METHODS
  We retrospectively analysed histopathological data from 214 patients who were transplanted in our Institution including 68 patients who underwent TIPS placement before transplantation. Pathological lesions from explanted livers, including incidental hepatocellular carcinoma, small cell dysplasia and large cell dysplasia were recorded.
  
  
  RESULTS
  Pathological lesions were found in 36.4% of explanted livers. TIPS insertion was an independent risk factor for pathological lesion (HR = 2.11, p < 0.05), concurrently with age (HR = 1.10 per year, p < 0.001) and viral aetiology of cirrhosis (HR = 3.05, p < 0.001). When considering the different type of lesions, TIPS insertion was not associated with an increased risk for hepatocellular carcinoma but was an independent risk factor for liver dysplasia (HR = 2.15, p = 0.042).
  
  
  CONCLUSIONS
  Although a direct relationship between TIPS insertion and hepatocellular carcinoma risk was not demonstrated in this study, the increased frequency of liver dysplasia observed in TIPS-bearing explanted livers deserves further prospective investigations with adequate follow-up.
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital de la Conception, Marseille, France; UMR 911, Université de la Méditerranée, Marseille, France. Electronic address: patrick.borentain@ap-hm.fr.
authors.forename: Patrick
authors.initials: P
authors.lastname: Borentain
authors.affiliation: Department of Pathology, Hôpital Nord, Marseille, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Department of Surgery and Liver Transplantation, Hôpital de la Conception, Marseille, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Gregoire
authors.affiliation: Department of Radiology, Hôpital de la Timone, Marseille, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Vidal
authors.affiliation: Department of Surgery and Liver Transplantation, Hôpital de la Conception, Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Ananian
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital de la Conception, Marseille, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Ressiot
authors.affiliation: Department of Surgery and Liver Transplantation, Hôpital de la Conception, Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Hardwigsen
authors.affiliation: Department of Radiology, Hôpital de la Timone, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Bartoli
authors.affiliation: Department of Radiology, Hôpital de la Timone, Marseille, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Moulin
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital de la Conception, Marseille, France.
authors.forename: Danielle
authors.initials: D
authors.lastname: Botta-Fridlund
authors.affiliation: Department of Surgery and Liver Transplantation, Hôpital de la Conception, Marseille, France.
authors.forename: Yves Patrice
authors.initials: YP
authors.lastname: Le Treut
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital de la Conception, Marseille, France; UMR 911, Université de la Méditerranée, Marseille, France.
authors.forename: Rene
authors.initials: R
authors.lastname: Gerolami
mesh_terms: D000328:Adult; D000367:Age Factors; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D005260:Female; D006498:Hepatectomy; D022781:Hepatocytes / Q000473:pathology*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000453:epidemiology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Hepatocellular carcinoma; Large cell dysplasia; Liver transplantation; Small cell dysplasia; Transjugular portosystemic shunt