Covered transjugular intrahepatic portosystemic shunt improves hypersplenism-associated cytopenia in cirrhosis

Background and aims Splenomegaly is common in cirrhotic patients with portal hypertension(PH), and PH-associated hypersplenism may cause severe cytopenia in all three hematopoietic lines. Decompression of splenic congestion by transjugular intrahepatic portosystemic shunt(TIPS) implantation may ameliorate hypersplenism, but data on the dynamics of all cell lines and their correlation with splenomegaly are scarce.

Methods Retrospective cohort study. Patients with malignancies or hematologic disorders were excluded. Hematology lab work was recorded at baseline (pre-TIPS) and at months(M) 3, 6, 12 and 24 after TIPS. Spleen size was documented at baseline and follow-up, if available.

Results 192 patients (male:72.4 %, age:56±10 years; MELD:12.1±3.6) underwent TIPS implantation for ascites (n = 109;56.8 %) and variceal bleeding (n = 83; 43.2 %). Pre-TIPS thrombocytopenia ≥grade(G)2 (PLT<100 G/L), anemia ≥G2 (Hb<10g/dL) and leukopenia ≥G2 (WBC<2G/L) were present in 55(28.7 %), 57(29.7 %), and 3(1.6 %) patients, respectively. Resolution of ≥G2 thrombocytopenia, G≥2 anemia, and leukopenia were observed in 24/55 (43.6 %), 23/57 (40.4 %) and 2/3 (66.7 %) of patients, respectively. 89.6 % of patients with available cross-sectional imaging presented with splenomegaly. Pre-TIPS spleen size correlated inversely with PLT (ρ=-0.4696; p<0.0001) and WBC (ρ=-0.3798; p = 0.0015), but not with Hb (ρ=0.0816 p = 0.5115). A decrease in spleen diameter by ≥10 % was only seen 9.1 % of patients within 12 months after TIPS, but was observed in 29.0 % on imaging that was performed later than 12 months after TIPS. Changes in spleen diameter after TIPS were not associated with amelioration/progression of thrombocytopenia (p = 504), anemia (p = 0.105) or leukopenia (p = 0.713), not even in patients with advanced stages at baseline (p>0.05 each).

Conclusion Thrombocytopenia with PLT<100G/L, anemia with Hb<10g/L, and leukopenia often improved after TIPS implantation. Since spleen size remained mostly stable after TIPS, mechanisms other than hypersplenism may play a pathophysiological role.

Publication History

Article published online:
01 September 2021