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Semin Liver Dis 2018; 38(01): 087-096
DOI: 10.1055/s-0038-1627457
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Does Transjugular Intrahepatic Portosystemic Shunt Stent Differentially Improve Survival in a Subset of Cirrhotic Patients?

Jonel Trebicka
1   Department of Internal Medicine I, University of Bonn, Bonn, Germany
2   European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
› Author Affiliations Funding The author has received grants and/or honoraria from Alexion, Bayer, BMS, Falk Pharma, Gilead, Grifols, Sequana Medical, and W.L. Gore & Associates. The author is supported by Deutsche Forschungsgemeinschaft (SFB-TRR57 P18), Cellex Foundation, and the European Union's Horizon 2020 Research and Innovation Program (No 668031).
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Publication History

Publication Date:
22 February 2018 (online)

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Abstract

Does transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment. While TIPS does not improve survival in other situations, it improves disease management, especially in patients without TIPS contraindications but with refractory bleeding, early rebleeding, portal vein thrombosis, and hepatorenal syndrome. Experience gained at the centers and follow-up of TIPS patients are key features that improve outcome. Important factors for selection and follow-up include cardiac function, inflammation, sarcopenia, age, and early evaluation for liver transplantation.

Keywords

variceal bleeding - refractory ascites - portal hypertension - systemic inflammation - sarcopenia
 

  • References

  • 1 Williams R, Aspinall R, Bellis M. , et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet 2014; 384 (9958): 1953-1997
    CrossrefPubMedGoogle Scholar
  • 2 Murray CJ, Barber RM, Foreman KJ. , et al; GBD 2013 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet 2015; 386 (10009): 2145-2191
    CrossrefPubMedGoogle Scholar
  • 3 Sheron N. Alcohol and liver disease in Europe--simple measures have the potential to prevent tens of thousands of premature deaths. J Hepatol 2016; 64 (04) 957-967
    CrossrefPubMedGoogle Scholar
  • 4 Mokdad AA, Lopez AD, Shahraz S. , et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med 2014; 12: 145
    CrossrefPubMedGoogle Scholar
  • 5 Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology 2018; 67 (01) 123-133
    CrossrefPubMedGoogle Scholar
  • 6 Bosch J, Abraldes JG, Berzigotti A, García-Pagan JC. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol 2009; 6 (10) 573-582
    CrossrefPubMedGoogle Scholar
  • 7 Kleber G, Sauerbruch T, Fischer G, Paumgartner G. Pressure of intraoesophageal varices assessed by fine needle puncture: its relation to endoscopic signs and severity of liver disease in patients with cirrhosis. Gut 1989; 30 (02) 228-232
    CrossrefPubMedGoogle Scholar
  • 8 de Franchis R. ; Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53 (04) 762-768
    CrossrefPubMedGoogle Scholar
  • 9 de Franchis R. ; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63 (03) 743-752
    CrossrefPubMedGoogle Scholar
  • 10 Villanueva C, Graupera I, Aracil C. , et al. A randomized trial to assess whether portal pressure guided therapy to prevent variceal rebleeding improves survival in cirrhosis. Hepatology 2017; 65 (05) 1693-1707
    CrossrefPubMedGoogle Scholar
  • 11 Rössle M. TIPS: 25 years later. J Hepatol 2013; 59 (05) 1081-1093
    CrossrefPubMedGoogle Scholar
  • 12 Silva-Junior G, Turon F, Baiges A. , et al. Timing affects measurement of portal pressure gradient after placement of transjugular intrahepatic portosystemic shunts in patients with portal hypertension. Gastroenterology 2017; 152 (06) 1358-1365
    CrossrefPubMedGoogle Scholar
  • 13 Wong F. Recent advances in our understanding of hepatorenal syndrome. Nat Rev Gastroenterol Hepatol 2012; 9 (07) 382-391
    CrossrefPubMedGoogle Scholar
  • 14 Tan HK, James PD, Sniderman KW, Wong F. Long-term clinical outcome of patients with cirrhosis and refractory ascites treated with transjugular intrahepatic portosystemic shunt insertion. J Gastroenterol Hepatol 2015; 30 (02) 389-395
    CrossrefPubMedGoogle Scholar
  • 15 Conn HO. Why do varices bleed? Rational therapy based on objective observations. Acta Med Scand Suppl 1985; 703: 135-148
    PubMedGoogle Scholar
  • 16 Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60 (08) 646-649
    CrossrefPubMedGoogle Scholar
  • 17 Escorsell À, Pavel O, Cárdenas A. , et al; Variceal Bleeding Study Group. Esophageal balloon tamponade versus esophageal stent in controlling acute refractory variceal bleeding: a multicenter randomized, controlled trial. Hepatology 2016; 63 (06) 1957-1967
    CrossrefPubMedGoogle Scholar
  • 18 Trebicka J. Emergency TIPS in a Child-Pugh B patient: when does the window of opportunity open and close?. J Hepatol 2017; 66 (02) 442-450
    CrossrefPubMedGoogle Scholar
  • 19 Orloff MJ, Vaida F, Haynes KS, Hye RJ, Isenberg JI, Jinich-Brook H. Randomized controlled trial of emergency transjugular intrahepatic portosystemic shunt versus emergency portacaval shunt treatment of acute bleeding esophageal varices in cirrhosis. J Gastrointest Surg 2012; 16 (11) 2094-2111
    CrossrefPubMedGoogle Scholar
  • 20 Orloff MJ. Fifty-three years' experience with randomized clinical trials of emergency portacaval shunt for bleeding esophageal varices in Cirrhosis: 1958-2011. JAMA Surg 2014; 149 (02) 155-169
    CrossrefPubMedGoogle Scholar
  • 21 Halabi SA, Sawas T, Sadat B. , et al. Early TIPS versus endoscopic therapy for secondary prophylaxis after management of acute esophageal variceal bleeding in cirrhotic patients: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 2016; 31 (09) 1519-1526
    CrossrefPubMedGoogle Scholar
  • 22 Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000; 31 (04) 864-871
    CrossrefPubMedGoogle Scholar
  • 23 Monescillo A, Martínez-Lagares F, Ruiz-del-Arbol L. , et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology 2004; 40 (04) 793-801
    CrossrefPubMedGoogle Scholar
  • 24 García-Pagán JC, Caca K, Bureau C. , et al; Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362 (25) 2370-2379
    CrossrefPubMedGoogle Scholar
  • 25 Garcia-Pagán JC, Di Pascoli M, Caca K. , et al. Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study. J Hepatol 2013; 58 (01) 45-50
    CrossrefPubMedGoogle Scholar
  • 26 Rudler M, Cluzel P, Corvec TL. , et al. Early-TIPSS placement prevents rebleeding in high-risk patients with variceal bleeding, without improving survival. Aliment Pharmacol Ther 2014; 40 (09) 1074-1080
    CrossrefPubMedGoogle Scholar
  • 27 Deltenre P, Trépo E, Rudler M. , et al. Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding: a systematic review and meta-analysis of controlled trials. Eur J Gastroenterol Hepatol 2015; 27 (09) e1-e9
    CrossrefPubMedGoogle Scholar
  • 28 Thabut D, Pauwels A, Carbonell N. , et al; des Hépato-Gastroentérologues des Hôpitaux Généraux (ANGH). Cirrhotic patients with portal hypertension-related bleeding and an indication for early-TIPS: a large multicentre audit with real-life results. J Hepatol 2017; ; pii: S0168-8278(17)32281-X DOI: 10.1016/j.jhep.2017.09.002.
    CrossrefPubMedGoogle Scholar
  • 29 Holster IL, Tjwa ET, Moelker A. , et al. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy + β-blocker for prevention of variceal rebleeding. Hepatology 2016; 63 (02) 581-589
    CrossrefPubMedGoogle Scholar
  • 30 Sauerbruch T, Mengel M, Dollinger M. , et al; German Study Group for Prophylaxis of Variceal Rebleeding. Prevention of rebleeding from esophageal varices in patients with cirrhosis receiving small-diameter stents versus hemodynamically controlled medical therapy. Gastroenterology 2015; 149 (03) 660-8.e1
    CrossrefPubMedGoogle Scholar
  • 31 Riggio O, Nardelli S, Moscucci F, Pasquale C, Ridola L, Merli M. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Clin Liver Dis 2012; 16 (01) 133-146
    CrossrefPubMedGoogle Scholar
  • 32 Karvellas CJ, Cardoso FS, Senzolo M. , et al. Clinical impact of portal vein thrombosis prior to liver transplantation: a retrospective cohort study. Ann Hepatol 2017; 16 (02) 236-436
    PubMedGoogle Scholar
  • 33 Luca A, Miraglia R, Caruso S. , et al. Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis. Gut 2011; 60 (06) 846-852
    CrossrefPubMedGoogle Scholar
  • 34 Lv Y, He C, Wang Z. , et al. Association of nonmalignant portal vein thrombosis and outcomes after transjugular intrahepatic portosystemic shunt in patients with cirrhosis. Radiology 2017; 285 (03) 999-1010
    CrossrefPubMedGoogle Scholar
  • 35 Fanelli F, Angeloni S, Salvatori FM. , et al. Transjugular intrahepatic portosystemic shunt with expanded-polytetrafuoroethylene-covered stents in non-cirrhotic patients with portal cavernoma. Dig Liver Dis 2011; 43 (01) 78-84
    CrossrefPubMedGoogle Scholar
  • 36 Klinger C, Riecken B, Schmidt A. , et al. Transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis. Z Gastroenterol 2017; DOI: 10.1055/s-0043-121348.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Klinger C, Riecken B, Schmidt A. , et al. Transjugular local thrombolysis with/without TIPS in patients with acute non-cirrhotic, non-malignant portal vein thrombosis. Dig Liver Dis 2017; 49 (12) 1345-1352
    CrossrefPubMedGoogle Scholar
  • 38 Senzolo M, , M Sartori T, Rossetto V. , et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int 2012; 32 (06) 919-927
    CrossrefPubMedGoogle Scholar
  • 39 Lv Y, Qi X, He C. , et al; PVT-TIPS Study Group. Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial. Gut 2017; DOI: 10.1136/gutjnl-2017-314634.
    CrossrefPubMedGoogle Scholar
  • 40 Wang Q, Lv Y, Bai M. , et al. Eight millimeter covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding. J Hepatol 2017; 67 (03) 508-516
    CrossrefPubMedGoogle Scholar
  • 41 Salerno F, Cammà C, Enea M, Rössle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology 2007; 133 (03) 825-834
    CrossrefPubMedGoogle Scholar
  • 42 Bai M, Qi XS, Yang ZP, Yang M, Fan DM, Han GH. TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: an updated meta-analysis. World J Gastroenterol 2014; 20 (10) 2704-2714
    CrossrefPubMedGoogle Scholar
  • 43 Riggio O, Ridola L, Angeloni S. , et al. Clinical efficacy of transjugular intrahepatic portosystemic shunt created with covered stents with different diameters: results of a randomized controlled trial. J Hepatol 2010; 53 (02) 267-272
    CrossrefPubMedGoogle Scholar
  • 44 Qi X, Tian Y, Zhang W, Yang Z, Guo X. Covered versus bare stents for transjugular intrahepatic portosystemic shunt: an updated meta-analysis of randomized controlled trials. Therap Adv Gastroenterol 2017; 10 (01) 32-41
    CrossrefPubMedGoogle Scholar
  • 45 Bureau C, Thabut D, Oberti F. , et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology 2017; 152 (01) 157-163
    CrossrefPubMedGoogle Scholar
  • 46 Siegerstetter V, Deibert P, Ochs A, Olschewski M, Blum HE, Rössle M. Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients. Eur J Gastroenterol Hepatol 2001; 13 (05) 529-534
    CrossrefPubMedGoogle Scholar
  • 47 Badillo R, Rockey DC. Hepatic hydrothorax: clinical features, management, and outcomes in 77 patients and review of the literature. Medicine (Baltimore) 2014; 93 (03) 135-142
    CrossrefPubMedGoogle Scholar
  • 48 Wong F, Sniderman K, Liu P, Blendis L. The mechanism of the initial natriuresis after transjugular intrahepatic portosystemic shunt. Gastroenterology 1997; 112 (03) 899-907
    CrossrefPubMedGoogle Scholar
  • 49 Brensing KA, Textor J, Perz J. , et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study. Gut 2000; 47 (02) 288-295
    CrossrefPubMedGoogle Scholar
  • 50 Allegretti AS, Ortiz G, Cui J. , et al. Changes in kidney function after transjugular intrahepatic portosystemic shunts versus large-volume paracentesis in cirrhosis: a matched cohort analysis. Am J Kidney Dis 2016; 68 (03) 381-391
    CrossrefPubMedGoogle Scholar
  • 51 Wiesner RH, McDiarmid SV, Kamath PS. , et al. MELD and PELD: application of survival models to liver allocation. Liver Transpl 2001; 7 (07) 567-580
    CrossrefPubMedGoogle Scholar
  • 52 Kim WR, Biggins SW, Kremers WK. , et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008; 359 (10) 1018-1026
    CrossrefPubMedGoogle Scholar
  • 53 Wannhoff A, Hippchen T, Weiss CS. , et al. Cardiac volume overload and pulmonary hypertension in long-term follow-up of patients with a transjugular intrahepatic portosystemic shunt. Aliment Pharmacol Ther 2016; 43 (09) 955-965
    CrossrefPubMedGoogle Scholar
  • 54 Sarwar A, Zhou L, Novack V. , et al. Hospital volume and mortality after transjugular intrahepatic portosystemic shunt creation in the United States. Hepatology 2017
    PubMedGoogle Scholar
  • 55 Salerno F, Merli M, Cazzaniga M. , et al. MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol 2002; 36 (04) 494-500
    CrossrefPubMedGoogle Scholar
  • 56 Angermayr B, Cejna M, Karnel F. , et al. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut 2003; 52 (06) 879-885
    CrossrefPubMedGoogle Scholar
  • 57 Luca A, Miraglia R, Maruzzelli L, D'Amico M, Tuzzolino F. Early liver failure after transjugular intrahepatic portosystemic shunt in patients with cirrhosis with model for end-stage liver disease score of 12 or less: incidence, outcome, and prognostic factors. Radiology 2016; 280 (02) 622-629
    CrossrefPubMedGoogle Scholar
  • 58 Fagiuoli S, Bruno R, Debernardi Venon W. , et al; AISF TIPS Special Conference. Consensus conference on TIPS management: techniques, indications, contraindications. Dig Liver Dis 2017; 49 (02) 121-137
    CrossrefPubMedGoogle Scholar
  • 59 Bureau C, Métivier S, D'Amico M. , et al. Serum bilirubin and platelet count: a simple predictive model for survival in patients with refractory ascites treated by TIPS. J Hepatol 2011; 54 (05) 901-907
    CrossrefPubMedGoogle Scholar
  • 60 Vilstrup H, Amodio P, Bajaj J. , et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014; 60 (02) 715-735
    CrossrefPubMedGoogle Scholar
  • 61 Wong F, Sniderman K, Liu P, Allidina Y, Sherman M, Blendis L. Transjugular intrahepatic portosystemic stent shunt: effects on hemodynamics and sodium homeostasis in cirrhosis and refractory ascites. Ann Intern Med 1995; 122 (11) 816-822
    CrossrefPubMedGoogle Scholar
  • 62 Merli M, Valeriano V, Funaro S. , et al. Modifications of cardiac function in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS). Am J Gastroenterol 2002; 97 (01) 142-148
    CrossrefPubMedGoogle Scholar
  • 63 Stankovic Z, Rössle M, Euringer W. , et al. Effect of TIPS placement on portal and splanchnic arterial blood flow in 4-dimensional flow MRI. Eur Radiol 2015; 25 (09) 2634-2640
    CrossrefPubMedGoogle Scholar
  • 64 Cazzaniga M, Salerno F, Pagnozzi G. , et al. Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt. Gut 2007; 56 (06) 869-875
    CrossrefPubMedGoogle Scholar
  • 65 Wiese S, Hove JD, Bendtsen F, Møller S. Cirrhotic cardiomyopathy: pathogenesis and clinical relevance. Nat Rev Gastroenterol Hepatol 2014; 11 (03) 177-186
    CrossrefPubMedGoogle Scholar
  • 66 Busk TM, Bendtsen F, Henriksen JH. , et al. Effects of transjugular intrahepatic portosystemic shunt (TIPS) on blood volume distribution in patients with cirrhosis. Dig Liver Dis 2017; 49 (12) 1353-1359
    CrossrefPubMedGoogle Scholar
  • 67 Busk TM, Bendtsen F, Poulsen JH. , et al. Transjugular intrahepatic portosystemic shunt: impact on systemic haemodynamics and renal and cardiac function in patients with cirrhosis. Am J Physiol Gastrointest Liver Physiol 2017; DOI: 10.1152/ajpgi.00094.2017.
    CrossrefPubMedGoogle Scholar
  • 68 Nazar A, Guevara M, Sitges M. , et al. LEFT ventricular function assessed by echocardiography in cirrhosis: relationship to systemic hemodynamics and renal dysfunction. J Hepatol 2013; 58 (01) 51-57
    CrossrefPubMedGoogle Scholar
  • 69 Merli M, Torromeo C, Giusto M, Iacovone G, Riggio O, Puddu PE. Survival at 2 years among liver cirrhotic patients is influenced by left atrial volume and left ventricular mass. Liver Int 2017; 37 (05) 700-706
    CrossrefPubMedGoogle Scholar
  • 70 Jansen C, Cox A, Schueler R. , et al. Increased myocardial contractility identifies patients with decompensated cirrhosis requiring liver transplantation. Liver Transpl 2018; 24 (01) 15-25
    CrossrefPubMedGoogle Scholar
  • 71 Baratta L, Tubani L, Merli M. , et al. Long-term effect of liver transplantation on cirrhotic autonomic cardiac dysfunction. Dig Liver Dis 2010; 42 (02) 131-136
    CrossrefPubMedGoogle Scholar
  • 72 Trevisani F, Merli M, Savelli F. , et al. QT interval in patients with non-cirrhotic portal hypertension and in cirrhotic patients treated with transjugular intrahepatic porto-systemic shunt. J Hepatol 2003; 38 (04) 461-467
    CrossrefPubMedGoogle Scholar
  • 73 Holland-Fischer P, Grønbæk H, Sandahl TD. , et al. Kupffer cells are activated in cirrhotic portal hypertension and not normalised by TIPS. Gut 2011; 60 (10) 1389-1393
    CrossrefPubMedGoogle Scholar
  • 74 Trebicka J, Krag A, Gansweid S. , et al. Endotoxin and tumor necrosis factor-receptor levels in portal and hepatic vein of patients with alcoholic liver cirrhosis receiving elective transjugular intrahepatic portosystemic shunt. Eur J Gastroenterol Hepatol 2011; 23 (12) 1218-1225
    CrossrefPubMedGoogle Scholar
  • 75 Trebicka J, Krag A, Gansweid S. , et al. Soluble TNF-alpha-receptors I are prognostic markers in TIPS-treated patients with cirrhosis and portal hypertension. PLoS One 2013; 8 (12) e83341
    CrossrefPubMedGoogle Scholar
  • 76 Berres ML, Asmacher S, Lehmann J. , et al. CXCL9 is a prognostic marker in patients with liver cirrhosis receiving transjugular intrahepatic portosystemic shunt. J Hepatol 2015; 62 (02) 332-339
    CrossrefPubMedGoogle Scholar
  • 77 Berres ML, Lehmann J, Jansen C. , et al. Chemokine (C-X-C motif) ligand 11 levels predict survival in cirrhotic patients with transjugular intrahepatic portosystemic shunt. Liver Int 2016; 36 (03) 386-394
    CrossrefPubMedGoogle Scholar
  • 78 Jansen C, Möller P, Meyer C. , et al. Increase in liver stiffness after transjugular intrahepatic portosystemic shunt is associated with inflammation and predicts mortality. Hepatology 2017; DOI: 10.1002/hep.29612.
    CrossrefPubMedGoogle Scholar
  • 79 Lehmann JM, Claus K, Jansen C. , et al. Circulating CXCL10 in cirrhotic portal hypertension might reflect systemic inflammation and predict ACLF and mortality. Liver Int 2017; DOI: 10.1111/liv.13610.
    CrossrefPubMedGoogle Scholar
  • 80 Trebicka J. Predisposing factors in acute-on-chronic liver failure. Semin Liver Dis 2016; 36 (02) 167-173
    Article in Thieme ConnectPubMedGoogle Scholar
  • 81 Tsien C, Shah SN, McCullough AJ, Dasarathy S. Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent. Eur J Gastroenterol Hepatol 2013; 25 (01) 85-93
    CrossrefPubMedGoogle Scholar
  • 82 Borhofen SM, Gerner C, Lehmann J. , et al. The Royal Free Hospital-nutritional prioritizing tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci 2016; 61 (06) 1735-1743
    CrossrefPubMedGoogle Scholar
  • 83 Nardelli S, Lattanzi B, Torrisi S. , et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement. Clin Gastroenterol Hepatol 2017; 15 (06) 934-936
    CrossrefPubMedGoogle Scholar
  • 84 Praktiknjo M, Book M, Luetkens J. , et al. Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis. Hepatology 2017
    PubMedGoogle Scholar
  • 85 Tandon P, Raman M, Mourtzakis M, Merli M. A practical approach to nutritional screening and assessment in cirrhosis. Hepatology 2017; 65 (03) 1044-1057
    CrossrefPubMedGoogle Scholar