Outcome of Children with Transjugular Intrahepatic Portosystemic Shunt: A Meta-Analysis of Individual Patient Data.
Humans
Child
Hypertension, Portal
/ surgery
Portasystemic Shunt, Transjugular Intrahepatic
/ methods
Treatment Outcome
Retrospective Studies
Ascites
/ complications
Hepatic Encephalopathy
Esophageal and Gastric Varices
/ surgery
Gastrointestinal Hemorrhage
/ complications
Liver Cirrhosis
/ complications
Cirrhosis
Portal vein thrombosis
Transjugular intrahepatic portosystemic shunt
Journal
Cardiovascular and interventional radiology
ISSN: 1432-086X
Titre abrégé: Cardiovasc Intervent Radiol
Pays: United States
ID NLM: 8003538
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
03
04
2023
accepted:
20
07
2023
medline:
4
9
2023
pubmed:
3
8
2023
entrez:
2
8
2023
Statut:
ppublish
Résumé
The purpose of the study was to investigate outcome after pediatric transjugular intrahepatic portosystemic shunt (TIPS) with respect to survival MATERIAL AND METHODS: After searching for studies on TIPS in children in Ovid, Medline, Embase, Scopus and Cochrane published between 2000 and 2022, individual patient data were retrieved from five retrospective cohorts. Overall survival (OS) and transplant-free survival (TFS) were calculated using Kaplan-Meier analysis and log-rank test and compared to the indication (ascites vs. variceal bleeding) as well as to the level of obstruction (pre-hepatic vs. hepatic vs. post-hepatic). Additionally, TIPS patency was analyzed. n = 135 pediatric patients were included in the final analysis. Indication for pediatric TIPS creation was heterogeneous among the included studies. TIPS patency decreased from 6 to 24 months, subsequent pediatric liver transplantation was performed in 22/135 (16.3%) of cases. The presence of ascites was related with poorer TFS (HR 2.3, p = 0.023), while variceal bleeding was not associated with impaired survival. Analysis of the level of obstruction (pre-hepatic, hepatic and post-hepatic) failed to prove significantly reduced OS for post-hepatic obstruction (HR 3.2, p = 0.092) and TFS (HR 1.3, p = 0.057). There was no difference in OS and TFS according to age at time of TIPS placement. The presence of ascites associates with impaired survival after TIPS in children, with no differences in survival according to the age of the child. Interventional shunt procedures can be considered feasible for all ages. Level 2a.
Identifiants
pubmed: 37532945
doi: 10.1007/s00270-023-03520-z
pii: 10.1007/s00270-023-03520-z
pmc: PMC10471675
doi:
Types de publication
Meta-Analysis
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1203-1213Informations de copyright
© 2023. The Author(s).
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