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

Claus Christian Pieper*, Andreas Feißt, Carsten Meyer, Julian Luetkens, Michael Praktiknjo, Jonel Trebicka, Ulrike Attenberger, Christian Jansen

*Kontaktforfatter

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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.

OriginalsprogEngelsk
Artikelnummer7065
TidsskriftScientific Reports
Vol/bind11
Udgave nummer1
ISSN2045-2322
DOI
StatusUdgivet - dec. 2021

Bibliografisk note

Funding Information:
Open Access funding enabled and organized by Projekt DEAL. The authors of this manuscript declare relationships with the following companies: CCP: Speakers Bureau: Guerbet, Philips Healthcare and Bayer Vital; Grant support: Guerbet, Medserena AG; CM: Speakers Bureau: Gore Medical; JT is supported by grants from the Deutsche Forschungsgemeinschaft (SFB TRR57 to P18), European Union’s Horizon 2020 Research and Innovation Programme (No. 668031) and Societal Challenges (Health, demographic change and well-being (No. 731875), and Cellex Foundation (PREDICT). UA: Speakers Bureau: Siemens Healthcare.

Publisher Copyright:
© 2021, The Author(s).

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