Z Gastroenterol 2018; 56(01): E2-E89
DOI: 10.1055/s-0037-1612666
Lectures Session II Clinical Hepatology – Friday, January 26, 2018, 3:20pm – 4:05pm, Lecture Hall A
Georg Thieme Verlag KG Stuttgart · New York

Does TIPS reduce the risk for HCC development in liver cirrhosis patients?

A Hüsing-Kabar
1   Universitätsklinikum Münster, Klinik für Gastroenterologie und Hepatologie, Münster
,
M Köhler
2   Universitätsklinikum Münster, Institut für klinische Radiologie, Münster
,
C Wilms
1   Universitätsklinikum Münster, Klinik für Gastroenterologie und Hepatologie, Münster
,
I Kabar
1   Universitätsklinikum Münster, Klinik für Gastroenterologie und Hepatologie, Münster
,
H Schmidt
1   Universitätsklinikum Münster, Klinik für Gastroenterologie und Hepatologie, Münster
,
H Heinzow
1   Universitätsklinikum Münster, Klinik für Gastroenterologie und Hepatologie, Münster
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2018 (online)

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Background:

Liver cirrhosis favors portal hypertension which causes complications like variceal bleeding, therapy-refractory ascites, and hepatorenal syndrome. Transjugular intrahepatic portosystemic shunt (TIPS) is used for the treatment of portal hypertension. However, parenchymal portal venous flow after TIPS insertion is reduced. TIPS therefore might induce ischemic liver injury which has been discussed to favor hepatocarcinogenesis resulting in the development of hepatocellular cancer (HCC).

Aim:

This study aimed to explore the association between TIPS placement and the risk of development of HCC in liver cirrhosis.

Methods:

1338 consecutive liver cirrhosis patients were included in this study between 01/2004 and 12/2015. Follow-up data were retrospectively analyzed with regard to development of HCC. Statistics included binary logistic regression and Kaplan-Meier analyses and were analyzed with regard to the assessment of risk factors for HCC development. Furthermore, case-control matching was performed based on gender, age, model of end-stage liver disease (MELD) score and underlying cause of cirrhosis (NASH, alcoholic liver disease and viral hepatitis) to rule out confounders of group heterogeneity.

Results:

Alcoholic liver disease, NASH, viral hepatitis, patient age and sex are established risk factors for the development of HCC in cirrhotic patients. Statistical analysis revealed the absence of TIPS insertion as a risk factor for HCC development. Matched-pair analysis of 432 patients showed a significant difference (p = 0.003) for the development of HCC in the TIPS placement versus the no-TIPS patient cohort. Episodes of hepatic encephalopathy or spontaneous bacterial peritonitis were not associated with higher risk of HCC development.

Conclusion:

TIPS insertion is significantly negatively correlated with the emergence of HCC in a large patient cohort calculated via Kaplan-Meier and multivariate analysis and is significantly associated with reduced risk of development of HCC in liver cirrhosis patients.