title: Role of the transjugular intrahepatic portosystemic shunt in the management of severe complications of portal hypertension in idiopathic noncirrhotic portal hypertension.
abstract: Idiopathic noncirrhotic portal hypertension is a heterogeneous group of diseases characterized by portal hypertension in the absence of cirrhosis. The efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in this population are unknown. The charts of patients with idiopathic noncirrhotic portal hypertension undergoing TIPS in seven centers between 2000 and 2014 were retrospectively reviewed. Forty-one patients were included. Indications for TIPS were recurrent variceal bleeding (n = 25) and refractory ascites (n = 16). Patients were categorized according to the presence (n = 27) or absence (n = 14) of significant extrahepatic comorbidities. Associated conditions were hematologic, prothrombotic, neoplastic, immune, and exposure to toxins. During follow-up (mean 27 ± 29 months), variceal rebleeding occurred in 7/25 (28%), including three with early thrombosis of the stent. Post-TIPS overt hepatic encephalopathy was present in 14 patients (34%). Eleven patients died, five due the liver disease or complications of the procedure and six because of the associated comorbidities. The procedure was complicated by hemoperitoneum in four patients (10%), which was fatal in one case. Serum creatinine (P = 0.005), ascites as indication for TIPS (P = 0.04), and the presence of significant comorbidities (P = 0.01) at the time of the procedure were associated with death. Mortality was higher in patients with significant comorbidities and creatinine ≥100 μmol/L (P < 0.001).
  
  
  
  In patients with idiopathic noncirrhotic portal hypertension who have normal kidney function or do not have severe extrahepatic conditions, TIPS is an excellent option to treat severe complications of portal hypertension. (Hepatology 2016;64:224-231).
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Département Epidémiologie et Recherche Clinique, Hôpital Beaujon, APHP, Clichy, France.|Service d'hépatologie, Hôpital Saint-Luc, Montréal, Canada.
authors.forename: Julien
authors.initials: J
authors.lastname: Bissonnette
authors.affiliation: Barcelona Hepatic Hemodynamic Lab and Liver Unit, Hospital Clinic-IDIBAPS and CIBERehd, University of Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Pagán
authors.affiliation: Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERehd, University of Alcalá, Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Albillos
authors.affiliation: Barcelona Hepatic Hemodynamic Lab and Liver Unit, Hospital Clinic-IDIBAPS and CIBERehd, University of Barcelona, Spain.
authors.forename: Fanny
authors.initials: F
authors.lastname: Turon
authors.affiliation: Barcelona Hepatic Hemodynamic Lab and Liver Unit, Hospital Clinic-IDIBAPS and CIBERehd, University of Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferreira
authors.affiliation: Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERehd, University of Alcalá, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Tellez
authors.affiliation: APHP, Hôpitaux Universitaires Paris-Seine Saint-Denis, Site Jean Verdier, Pôle d'Activité Cancérologique Spécialisée, Service d'Hépatologie, Bondy, Inserm, UMR-1162, Génomique fonctionnelle des Tumeurs solides, Equipe Labellisée Ligue Contre le Cancer, Paris, France.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Nault
authors.affiliation: Service d'hépatologie, Hôpital Saint-Antoine, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carbonell
authors.affiliation: Service d'hépatologie, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cervoni
authors.affiliation: Service de radiologie, Hôpital Beaujon, Clichy, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel Rehim
authors.affiliation: Service de radiologie, Hôpital Beaujon, Clichy, France.
authors.forename: Annie
authors.initials: A
authors.lastname: Sibert
authors.affiliation: Service de radiologie, Hôpital Saint-Luc, Montréal, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Bouchard
authors.affiliation: Service de radiologie, Hôpital Saint-Luc, Montréal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Perreault
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors.forename: Jonel
authors.initials: J
authors.lastname: Trebicka
authors.affiliation: Service d'hépatologie, Hôpital Saint-Luc, Montréal, Canada.
authors.forename: Félix
authors.initials: F
authors.lastname: Trottier-Tellier
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Département Epidémiologie et Recherche Clinique, Hôpital Beaujon, APHP, Clichy, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Rautou
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Département Epidémiologie et Recherche Clinique, Hôpital Beaujon, APHP, Clichy, France.
authors.forename: Dominique-Charles
authors.initials: DC
authors.lastname: Valla
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Département Epidémiologie et Recherche Clinique, Hôpital Beaujon, APHP, Clichy, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Plessier
mesh_terms: D000328:Adult; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies