Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis

Abstract The puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of TIPS-creation in cirrhotic patients. 93 cirrhotic patients (57 male, mean age 59 years) received CT prior to TIPS-creation. 38/93 additionally underwent post...

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Autores principales:	Claus Christian Pieper, Andreas Feißt, Carsten Meyer, Julian Luetkens, Michael Praktiknjo, Jonel Trebicka, Ulrike Attenberger, Christian Jansen
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/78d0df2d31184be795fbf081455d22fd
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spelling	oai:doaj.org-article:78d0df2d31184be795fbf081455d22fd2021-12-02T18:18:06ZImpact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis10.1038/s41598-021-86006-72045-2322https://doaj.org/article/78d0df2d31184be795fbf081455d22fd2021-03-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-86006-7https://doaj.org/toc/2045-2322Abstract The puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of TIPS-creation in cirrhotic patients. 93 cirrhotic patients (57 male, mean age 59 years) received CT prior to TIPS-creation. 38/93 additionally underwent post-interventional CT. CCh-diameter was measured. After categorization into patients with and without large venous collaterals (i.e. > 6 mm), data were analyzed regarding associations between CCh-diameter, clinical and portal-hemodynamic parameters and diameter-changes after TIPS-creation. Patient survival post-TIPS was analyzed. Median portosystemic pressure-gradient decreased from 20 to 9 mmHg after TIPS-creation. Large venous collaterals were observed in 59 patients. In 69/93 patients (74.2%) the CCh was detectable. Mean pre-interventional diameter was 9.4 ± 2.7 mm (large collaterals: 8.7 ± 2.0 mm, no large collaterals: 10.7 ± 3.2 mm, p = 0.003). CCh-diameter correlated strongly with pre-TIPS portal-pressure (Rs = 0.685, p = 0.0001), moderately with portosystemic-gradient (Rs = 0.524, p = 0.006), liver shear-wave-elastography (Rs = 0.597, p = 0.004) and spleen size (Rs = 0.501, p = 0.01) in patients without large collaterals, but not in patients with large collaterals. Post-TIPS CCh-diameter decreased significantly from 10.2 ± 2.8 mm to 8.3 ± 3.0 mm (p < 0.001). Patients without a detectable CCh on CT survived significantly shorter. The diameter of the CCh is associated with portal-pressure and decreases after TIPS-creation in cirrhotic patients, reflecting a portal decompression mechanism via the lymphatic system. Lack of larger central lymphatics detectable on CT may be associated with shorter survival.Claus Christian PieperAndreas FeißtCarsten MeyerJulian LuetkensMichael PraktiknjoJonel TrebickaUlrike AttenbergerChristian JansenNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Claus Christian Pieper Andreas Feißt Carsten Meyer Julian Luetkens Michael Praktiknjo Jonel Trebicka Ulrike Attenberger Christian Jansen Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis
description	Abstract The puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of TIPS-creation in cirrhotic patients. 93 cirrhotic patients (57 male, mean age 59 years) received CT prior to TIPS-creation. 38/93 additionally underwent post-interventional CT. CCh-diameter was measured. After categorization into patients with and without large venous collaterals (i.e. > 6 mm), data were analyzed regarding associations between CCh-diameter, clinical and portal-hemodynamic parameters and diameter-changes after TIPS-creation. Patient survival post-TIPS was analyzed. Median portosystemic pressure-gradient decreased from 20 to 9 mmHg after TIPS-creation. Large venous collaterals were observed in 59 patients. In 69/93 patients (74.2%) the CCh was detectable. Mean pre-interventional diameter was 9.4 ± 2.7 mm (large collaterals: 8.7 ± 2.0 mm, no large collaterals: 10.7 ± 3.2 mm, p = 0.003). CCh-diameter correlated strongly with pre-TIPS portal-pressure (Rs = 0.685, p = 0.0001), moderately with portosystemic-gradient (Rs = 0.524, p = 0.006), liver shear-wave-elastography (Rs = 0.597, p = 0.004) and spleen size (Rs = 0.501, p = 0.01) in patients without large collaterals, but not in patients with large collaterals. Post-TIPS CCh-diameter decreased significantly from 10.2 ± 2.8 mm to 8.3 ± 3.0 mm (p < 0.001). Patients without a detectable CCh on CT survived significantly shorter. The diameter of the CCh is associated with portal-pressure and decreases after TIPS-creation in cirrhotic patients, reflecting a portal decompression mechanism via the lymphatic system. Lack of larger central lymphatics detectable on CT may be associated with shorter survival.
format	article
author	Claus Christian Pieper Andreas Feißt Carsten Meyer Julian Luetkens Michael Praktiknjo Jonel Trebicka Ulrike Attenberger Christian Jansen
author_facet	Claus Christian Pieper Andreas Feißt Carsten Meyer Julian Luetkens Michael Praktiknjo Jonel Trebicka Ulrike Attenberger Christian Jansen
author_sort	Claus Christian Pieper
title	Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis
title_short	Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis
title_full	Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis
title_fullStr	Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis
title_full_unstemmed	Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis
title_sort	impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/78d0df2d31184be795fbf081455d22fd
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Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis

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