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Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding

  • Original Article―Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Measuring the portal pressure gradient from the portal vein (PV) to the inferior vena cava (IVC) or to the right atrium (RA) remains controversial. The aim of our study was to compare the predictive ability of portoatrial gradient (PAG) and portocaval gradient (PCG) for variceal rebleeding.

Methods

The data of 285 cirrhotic patients with variceal bleeding undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) in our hospital were analyzed retrospectively. The variceal rebleeding rates were compared between groups categorized by established or modified thresholds. The median follow-up time was 30.0 months.

Results

After TIPS, PAG was equal to (n = 115) or more than (n = 170) PCG. The pressure of IVC was defined as an independent predictor for a PAG-PCG difference of ≥ 2 mmHg (p < 0.001, OR 1.23, 95% CI 1.10–1.37). Using a threshold of 12 mmHg, PAG (p = 0.081, HR 0.63, 95% CI 0.37–1.06) could not predict variceal rebleeding but PCG could (p = 0.003, HR 0.45, 95% CI 0.26–0.77). This pattern was unchanged when a ≥ 50% reduction from baseline was also considered as a threshold (PAG/PCG: p = 0.114 and 0.001). Subgroup analyses showed that only in patients with post-TIPS IVC pressure < 9 mmHg (p = 0.018), PAG could predict variceal rebleeding. Because PAG was on average 1.4 mmHg higher than PCG, patients were classified by a PAG of 14 mmHg, and there was no difference in rebleeding rates between these two groups (p = 0.574).

Conclusions

For patients with variceal bleeding, the predictive ability of PAG is limited. The portal pressure gradient should be measured between the PV and IVC.

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Abbreviations

CI:

Confidence interval

GOV2:

Gastroesophageal varices type 2

HR:

Hazard ratio

IVC:

Inferior vena cava

IVCP:

Inferior vena cava pressure

MELD:

Model of end-stage liver disease

NSBBs:

Non-selective beta-blocks

OLT:

Orthotopic liver transplantation

PPG:

Portal pressure gradient

PAG:

Portoatrial gradient

PCG:

Portocaval gradient

PV:

Portal vein

PVP:

Portal vein pressure

RA:

Right atrium

RAP:

Right atrium pressure

sHR:

Subdistribution hazard ratio

SPSS:

Spontaneous portosystemic shunts

TIPS:

Transjugular intrahepatic portosystemic shunt

VRB:

Variceal rebleeding

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Acknowledgements

The authors thank for Danqing Zhao’s valuable statistical assistance.

Funding

This study was supported by grants from Device development exploration project from National Clinical Research Center for Interventional Medicine (2021–001), Shanghai key clinical specialty construction program (W2019028), Excellent youth program from Zhongshan Hospital, Fudan University (2019ZSYXQN38) and Clinical research special fund from Zhongshan Hospital, Fudan University (2018ZSLC23).

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Author notes

  1. Li Ma and Yaozu Liu shared co-first authorship.

Authors and Affiliations

  1. Shanghai Institution of Medical Imaging, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China

    Li Ma, Yaozu Liu, Zhiping Yan, Wen Zhang, Zihan Zhang, Minjie Yang, Jiaze Yu, Jingqin Ma & Jianjun Luo

  2. Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China

    Li Ma, Yaozu Liu, Zhiping Yan, Wen Zhang, Zihan Zhang, Minjie Yang, Jiaze Yu, Xin Zhou, Jingqin Ma & Jianjun Luo

  3. National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China

    Li Ma, Yaozu Liu, Zhiping Yan, Wen Zhang, Zihan Zhang, Minjie Yang, Jiaze Yu, Xin Zhou, Jingqin Ma & Jianjun Luo

  4. Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China

    Shiyao Chen & Jian Wang

  5. Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China

    Zhiping Yan & Jianjun Luo

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Contributions

Conceptualization: JL and JM; Methodology: ZY and JL; Formal analysis and investigation: YL, WZ, ZZ, MY, JY, XZ, SC and JW; Writing—original draft preparation: LM; Writing—review and editing: JL and JM. Funding acquisition: ZY, JL and JM; All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Jingqin Ma or Jianjun Luo.

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Conflict of interest

We declare no competing interests.

Ethical approval

The protocol of this study was approved by the ethics committee of Zhongshan hospital, Fudan university (No. B2022-017R). This study was conducted in accordance with the Helsinki Declaration.

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Ma, L., Liu, Y., Yan, Z. et al. Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding. J Gastroenterol 58, 494–502 (2023). https://doi.org/10.1007/s00535-023-01977-w

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  • DOI: https://doi.org/10.1007/s00535-023-01977-w

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