TY - JOUR
T1 - North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension
AU - Advancing Liver Therapeutic Approaches (ALTA) Consortium
AU - Boike, Justin R.
AU - Thornburg, Bartley G.
AU - Asrani, Sumeet K.
AU - Fallon, Michael B.
AU - Fortune, Brett E.
AU - Izzy, Manhal J.
AU - Verna, Elizabeth C.
AU - Abraldes, Juan G.
AU - Allegretti, Andrew S.
AU - Bajaj, Jasmohan S.
AU - Biggins, Scott W.
AU - Darcy, Michael D.
AU - Farr, Maryjane A.
AU - Farsad, Khashayar
AU - Garcia-Tsao, Guadalupe
AU - Hall, Shelley A.
AU - Jadlowiec, Caroline C.
AU - Krowka, Michael J.
AU - Laberge, Jeanne
AU - Lee, Edward W.
AU - Mulligan, David C.
AU - Nadim, Mitra K.
AU - Northup, Patrick G.
AU - Salem, Riad
AU - Shatzel, Joseph J.
AU - Shaw, Cathryn J.
AU - Simonetto, Douglas A.
AU - Susman, Jonathan
AU - Kolli, K. Pallav
AU - VanWagner, Lisa B.
N1 - Funding Information:
Conflicts of interest These authors disclose the following: Justin R. Boike and Bartley G. Thornburg have received personal fees from W.L. Gore and Associates during the course of this consensus statement; Brett E. Fortune has received consulting fees from W.L. Gore and Associates before this consensus conference; Elizabeth C. Verna has received grants from Salix Pharmaceuticals and serves on the Advisory Board for Gilead Sciences; Jasmohan S. Bajaj has received institutional grants from Bausch Health and serves on the advisory board for Norgine unrelated to this consensus statement; Khashayar Farsad consults for Cook Medical; David C. Mulligan serves as at-large representative on the Governing Board of the American Association for the Study of Liver Diseases and is President of the United Network of Organ Sharing and Organ Procurement and Transplant Network unrelated to this consensus statement; Joseph J. Shatzel has received consulting fees from Aronora, Inc, unrelated to this consensus statement; and Lisa B. VanWagner receives investigator-initiated grant support paid to the institution from W.L. Gore and Associates, serves as an expert witness, receives in-kind research support from AMRA Medical, participates as a member of the Global Liver Institute, serves as a member of the Practice Guidelines committee for the American Association for the Study of Liver Diseases, serves as Chair of the Executive Committee of the American Society for Liver Transplantation Liver and Intestine Community of Practice, is a member of the American Heart Association Epidemiology and Prevention Statistics Committee, serves as topic coordinator for the International Liver Transplantation Society Cardiovascular Disease Interest Group, is a member of the Board of Directors and Medical Advisory Committee for the American Liver Foundation Greater Lakes Region Division, and serves as an Associate Editor for the journals Clinical Liver Disease and Liver Transplantation. The remaining authors disclose no conflicts.
Funding Information:
Funding Supported by K23 HL136891 (L.B.V.) and R01HL151367 (J.J.S.) from the National Heart, Lung, and Blood Institute at the National Institutes of Health. Research Electronic Data Capture is supported by the Northwestern University Clinical and Translational Science Institute. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences grant UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. W.L. Gore and Associates awarded Northwestern University with an unrestricted educational grant, which generously supported the Advancing Liver Therapeutic Approaches Consensus Conference in the use of transjugular intrahepatic portosystemic shunt for the Management of Portal Hypertension, held virtually on Friday October 23, 2020. W.L. Gore and Associates and Cook Medical played no role in the concept, design, development, writing or review. W.L. Gore and Associates did not participate in the conference.
Publisher Copyright:
© 2022 The Authors
PY - 2022/8
Y1 - 2022/8
N2 - 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 where TIPS creation is performed primarily 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 group critically reviews the application of TIPS in the management of portal hypertension. Advancing Liver Therapeutic Approaches convened 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 patients 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 the prevention of complications. Finally, future research directions are identified related to TIPS for the management of portal hypertension.
AB - 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 where TIPS creation is performed primarily 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 group critically reviews the application of TIPS in the management of portal hypertension. Advancing Liver Therapeutic Approaches convened 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 patients 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 the prevention of complications. Finally, future research directions are identified related to TIPS for the management of portal hypertension.
KW - Ascites
KW - Cirrhosis
KW - Complications
KW - Consensus Statement
KW - End-Stage Liver Disease
KW - Guidance Document
KW - TIPS Procedure
KW - Variceal Bleeding
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U2 - 10.1016/j.cgh.2021.07.018
DO - 10.1016/j.cgh.2021.07.018
M3 - Review article
C2 - 34274511
AN - SCOPUS:85123282346
SN - 1542-3565
VL - 20
SP - 1636-1662.e36
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 8
ER -