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Complications of Cirrhosis |Abstract Library |
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North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension |
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Clin Gastroenterol Hepatol. 2021 Jul 15;S1542-3565(21)00749-7.doi: 10.1016/j.cgh.2021.07.018. Online ahead of print.
Justin R Boike 1, Bartley G Thornburg 2, Sumeet K Asrani 3, Michael B Fallon 4, Brett E Fortune 5, Manhal J Izzy 6, Elizabeth C Verna 7, Juan G Abraldes 8, Andrew S Allegretti 9, Jasmohan S Bajaj 10, Scott W Biggins 11, Michael D Darcy 12, Maryjane A Farr 13, Khashayar Farsad 14, Guadalupe Garcia-Tsao 15, Shelley A Hall 16, Caroline C Jadlowiec 17, Michael J Krowka 18, Jeanne Laberge 19, Edward W Lee 20, David C Mulligan 21, Mitra K Nadim 22, Patrick G Northup 23, Riad Salem 2, Joseph J Shatzel 24, Cathryn J Shaw 25, Douglas A Simonetto 26, Jonathan Susman 27, K Pallav Kolli 19, Lisa B VanWagner 28, Advancing Liver Therapeutic Approaches (ALTA) Consortium
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Author information
- 1Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- 2Department of Radiology, Division of Vascular and Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- 3Baylor University Medical Center, Dallas, TX, USA.
- 4Department of Medicine, Division of Gastroenterology and Hepatology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA.
- 5Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA.
- 6Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA.
- 7Department of Medicine, Division of Digestive and Liver Diseases, Columbia University College of Physicians & Surgeons, New York, NY, USA.
- 8Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, AB, Canada.
- 9Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA.
- 10Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA.
- 11Department of Medicine, Division of Gastroenterology & Hepatology, University of Washington Medical Center, Seattle, WA, USA.
- 12Department of Radiology, Division of Interventional Radiology, Washington University School of Medicine, St. Louis, MO, USA.
- 13Department of Medicine, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA.
- 14Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA.
- 15Department of Digestive Diseases, Yale University, Yale University School of Medicine, and VA-CT Healthcare System, CT, USA.
- 16Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA.
- 17Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
- 18Department of Pulmonary and Critical Care Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
- 19Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California San Francisco, San Francisco, CA, USA.
- 20Department of Radiology, Division of Interventional Radiology, University of California-Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
- 21Department of Surgery, Division of Transplantation, Yale University School of Medicine, New Haven, CT, USA.
- 22Department of Medicine, Division of Nephrology and Hypertension, University of Southern California, Los Angeles, California, USA.
- 23Department of Medicine, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA.
- 24Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR, USA.
- 25Department of Radiology, Division of Interventional Radiology, Baylor University Medical Center, Dallas, TX, USA.
- 26Department of Physiology, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
- 27Department of Radiology, Division of Interventional Radiology, Columbia University Irving Medical Center, New York, NY, USA.
- 28Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: lvw@northwestern.edu.
Abstract
Complications of portal hypertension, including ascites, gastrointestinal bleeding, hepatic hydrothorax, and hepatic encephalopathy are associated with significant morbidity and mortality. Despite few high quality randomized controlled trials to guide therapeutic decisions, transjugular intrahepatic portosystemic shunt (TIPS) creation has emerged as a crucial therapeutic option to treat complications of portal hypertension. In North America, the decision to perform TIPS involves gastroenterologists, hepatologists, and interventional radiologists, but TIPS creation is performed by interventional radiologists. This is in contrast to other parts of the world in which TIPS creation is primarily performed by hepatologists. Thus, the successful use of TIPS in North America is dependent on a multidisciplinary approach and technical expertise, so as to optimize outcomes. Recently, new procedural techniques, TIPS stent technology, and indications for TIPS have emerged. As a result, practices and outcomes vary greatly across institutions and significant knowledge gaps exist. In this Consensus statement, the Advancing Liver Therapeutic Approaches (ALTA) group critically reviews the application of TIPS in the management of portal hypertension. ALTA convened, for the first time, a multidisciplinary group of North American experts from hepatology, interventional radiology, transplant surgery, nephrology, cardiology, pulmonology, and hematology to critically review existing literature and develop practice-based recommendations for the use of TIPS in persons with any cause of portal hypertension in terms of candidate selection, procedural best practices and post-TIPS management; and to develop areas of consensus for TIPS indications and prevention of complications. Finally, future research directions are identified related to TIPS for the management of portal hypertension.
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