Effect Of Transjugular Intrahepatic Portosystemic Shunt On Hypersplenism Caused By Liver Cirrhosis

Background:Hypersplenism in cirrhosis was associated with portal hypertension,local and systemic multifactorial,and its manifestation of thrombocytopenia was the result of a combination of many factors.The role of portal vein pressure reduction in hypersplenism was not well established,and it was controversial whether transjugular intrahepatic portosystemic shunts（TIPS）improves hypersplenism in cirrhosis.Objective:To investigate whether TIPS can improve hypersplenism in liver cirrhosis.Methods:The data of patients who underwent TIPS for liver cirrhosis and were regularly followed up after TIPS from 2013 to 2022 at the first Affiliated Hospital of Nanchang University were retrospectively collected,including patients’preoperative liver and kidney function,blood routine,coagulation function and other clinical indicators.All patients were followed up for short term（3 months）and long term（1 year）postoperative related clinical indexes to compare the difference of platelets（PLT）,white blood cells（WBC）and hemoglobin（Hb）before and after TIPS.The degree of PLT,WBC and Hb reduction was divided into four strata from mild to severe,G0,G1,G2 and G3,respectively;the preoperative Model for end-stage liver disease（MELD score）was divided into two strata,M1（≤7 points）and M2（>7 points）,with a cut-off value of 7.The degree of improvement of Portal pressure gradient（PPG）after TIPS was divided into three strata,P1,P2 and P3,from high to low.To analyze whether preoperative different degrees of PLT、Hb、WBC,MELD score,and postoperative PPG reduction degree affect the outcome of PLT,Hb,and WBC result from TIPS.Results:1.A total of 164 patients were included in the study,in which ALT,AST and TBIL,DBIL were elevated 3 months after TIPS,MELD score was from 7.25 to 10.08（P<0.001）,CR was lower than before（P=0.040）,PT was longer than before（P<0.001）.2.The difference in PLT between preoperative and 3 months after TIPS was not statistically significant（54.50（40.00,82.25）×10^9/L,57.00（39.00,83.00）×10^9/L,p=0.920）,and the difference in PLT between preoperative and 1 year after TIPS was not statistically significant either（53.00（39.00,81.00）×10^9/L,56.00（39.00,86.00）×10^9/L,p=0.522）;there were no statistically significant change in the percentage of PLT strata at 3 months and 1 year after TIPS（p₁=0.671,p₂=0.101）.The difference in Hb between preoperative and 3 months postoperative was not statistically significant（83.85±20.17g/L,87.24±16.72 g/L,p=0.098）,and the Hb value of 1 year postoperative was higher than that of preoperative（92.29±24.02 g/L,81.71±16.75g/L,p=0.001）;the percentage of G3 in Hb at 3 months and 1 year postoperative were reduced compared with that of preoperative（all P values<0.005）.There was no statistically significant difference between preoperative and postoperative WBC value at 3 months after TIPS（3.02（2.14,4.59）×10^9/L,3.13（2.32,4.66）×10^9/L,p=0.540）,and no statistically significant difference between preoperative and postoperative WBC value at 1 year after TIPS（2.91（1.82,3.95）×10^9/L,3.22（2.11,4.15）×10^9/L,p=0.274）;there were no statistically significant difference in the percentage of WBC in each strata at 3months and 1 year after TIPS（p₁=0.345,p₂=0.306）.3.Grouped by preoperative MELD score stratum,calculated the differences in PLT,Hb,and WBC between M1 and M2 group at postoperative versus preoperative by a mixed-effects model.In the M1 group,the differences in PLT value between 3months,1 year postoperatively and preoperative were not statistically significant（p₁=0.455,p₂=0.775）.In the M2 group,PLT value of 1 year postoperative was higher than that of preoperative（p=0.015）,and the difference in PLT value between 3 months and preoperative was not statistically significant（p=0.976）.The differences in PLT value change 3 months and 1 year postoperatively between M1 and M2 group were not statistically significant（p₁=0.504,p₂=0.062）.In the M1 group,Hb value were higher at 3 months and 1 year postoperatively compared to preoperatively（p₁=0.027,p₂<0.001）.In the M2 group,Hb value was higher at 1 year postoperatively compared to preoperatively（p=0.028）,and the difference between 3 months and preoperatively was not statistically significant（p=0.547）.The differences in Hb value change at 3months and 1 year postoperatively between the M1 and M2 group were not statistically significant（p₁=0.371,p₂=0.810）.In the M1 group,the differences in WBC value between 3 months,1 year after TIPS and preoperative were not statistically significant（p₁=0.871,p₂=0.937）.In the M2 group,the differences in WBC value between 3months,1 year after TIPS and preoperative were not statistically significant（p₁=0.328,p₂=0.180）.The differences in WBC change 3 months and 1 year postoperatively between the M1 and M2 group were not statistically significant（p₁=0.556,p₂=0.301）.4.Grouped by the degree of postoperative PPG reduction,calculated the differences in PLT,Hb,and WBC between P1,P2 and P3 group at postoperative versus preoperative by a mixed-effects model.In the P1 group,the difference in PLT value was not statistically significant at 3 months postoperatively compared to preoperatively（p=0.330）,and PLT value was higher at 1 year postoperatively compared to preoperatively（p=0.006）.In the P2 group,the differences in PLT value between 3months,1 year after TIPS and preoperative were not statistically significant（p₁=0.635,p₂=0.334）.In the P3 group,the differences in PLT value between 3 months,1year after TIPS and preoperative were not statistically significant（p₁=0.588,p₂=0.964）.No statistically significant differences in PLT value change at 3months and 1 year after TIPS between P2 and P1 group（p₁=0.265,p₂=0.054）,and no statistically significant difference in PLT value change at 3 months after TIPS between P3 and P1 group（p=0.199）,but less improvement in P3 group than P1 group at 1 year after TIPS（p=0.041）.In the P1 group,the difference in Hb value was not statistically significant at 3 months postoperatively compared to preoperatively（p=0.364）,and Hb value was higher at 1 year postoperatively compared to preoperatively（p=0.008）.In the P2 group,the Hb values were higher at 3 months,1 year postoperatively compared to preoperatively（p₁=0.016,p₂<0.001）.In the P3 group,the differences in Hb value between 3 months,1 year after TIPS and preoperative were not statistically significant（p₁=0.908,p₂=0.624）.No statistically significant differences in Hb value change at 3months and 1 year after TIPS between P2 and P1 group（p₁=0.784,p₂=0.900）,and no statistically significant difference in Hb value change at 3 months after TIPS between P3 and P1 group（p=0.438）,but less improvement in P3 group than P1 group at 1 year after TIPS（p=0.016）.In the P1,P2 and P3 group,in terms of WBC values at 3 months and 1 year postoperatively compared to preoperatively were not statistically significant（all p values>0.05）,and the differences between the P2 and P1 group and between the P3 and P1 group in terms of WBC values change at 3 months and 1 year postoperatively were not statistically significant（all p values>0.05）.Conclusions:1.A 50%or more reduction in PPG after TIPS improves platelet levels in cirrhotic hypersplenism.platelet improvement after TIPS is associated with the degree of portal hypertension reduced by TIPS,independent of the degree of preoperative hypersplenism and liver function MELD score.2.Higher Hb 1 year after TIPS than before.No improvement in cirrhotic hypersplenism leukopenia at 3 months and 1 year after TIPS.