Transjugular Intrahepatic Portosystemic Shunts in Pediatric Portal Hypertension: A Systematic Review and Meta-Analysis
Institution:
1. Department of Vascular and Interventional Radiology, Ghent University Hospital, Ghent, Belgium;2. Department of Pediatrics, Ghent University Hospital, Ghent, Belgium;1. Cardiac Surgery Department, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain;2. Cardiac Surgery Department, Hospital Universitario de Navarra, Pamplona, Spain;3. Cardiac Surgery Department, Centro Cardiovascular Universitario, Universidad de la República, Montevideo, Uruguay;4. Cardiology Department, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain;5. Research Unit, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain;1. Boston University Chobanian & Avedisian School of Medicine, Boston, MA;2. Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215;1. Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong;2. Department of Radiology, 2/F, Block B, Hong Kong Children’s Hospital, 1 Shing Cheong Rd, Kowloon Bay, Hong Kong;3. Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong;1. Department of Radiology, University of California, Davis Medical Center, 4860 Y St, Suite 3100, Sacramento, CA 95817;2. Department of Interventional Radiology, Oregon Health & Science University, Portland, OR;3. Mercy Radiology Group, Department of Radiology, Sacramento, CA;4. Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Sacramento, CA;1. Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas;2. Section of Vascular Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy;3. Department of Interventional Radiology (B.Z.), University of South Florida Morsani College of Medicine, Tampa, Florida;4. StemRad Inc., Tampa, Florida;5. Division of Vascular Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida;6. Institute of Aerospace Medicine, Radiation Biology Department, German Aerospace Center, Cologne, Germany;7. Division of Vascular Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana
Abstract:
PurposeTo investigate the technical outcome, clinical outcome, and patency of transjugular intrahepatic portosystemic shunt (TIPS) in pediatric portal hypertension (PHT).MethodsA systematic search of MEDLINE/PubMed, EMBASE, Cochrane databases, ClinicalTrials.gov, and WHO ICTRP registries was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An a priori protocol was registered at the PROSPERO database. Original full-text articles on pediatric patients (sample size of ≥5 patients with upper age limit of 21 years) with PHT who underwent TIPS creation for any indication were included.ResultsSeventeen studies with 284 patients (average-weighted age of 10.1 years) were included, with an average-weighted follow-up of 3.6 years. TIPS was technically successful in 93.3% (95% confidence interval CI], 88.5%–97.1%) of patients, with a major adverse event rate of 3.2% (95% CI, 0.7–6.9) and adjusted hepatic encephalopathy rate of 2.9% (95% CI, 0.6–6.3). The pooled 2-year primary and secondary patency rates were 61.8% (95% CI, 50.0–72.4) and 99.8% (95% CI, 96.2%–100.0%), respectively. Stent type (P = .002) and age (P = .04) were identified as a significant source of heterogeneity for clinical success. In subgroup analysis, the clinical success rate was 85.9% (95% CI, 77.8–91.4) in studies with a majority of covered stents, and 87.6% (95% CI, 74.1–94.6) in studies with a median age of 12 years or older.ConclusionsThis systematic review and meta-analysis demonstrates that a TIPS is a feasible and safe treatment for pediatric PHT. To improve clinical outcome and patency on the long term, the use of covered stents should be encouraged.
