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Hepatobiliary Infection after Transjugular Intrahepatic Portosystemic Shunt Creation in Patients with Prior Biliary Intervention: A Multi-Institution Retrospective Study.

Publication ,  Journal Article
Ronald, J; Bartlett, D; Border, L; Fickert, J; Gaba, RC; Kim, J; Kord, A; Lokken, RP; Patel, M; Pollard, B; Ramsey, MT; Yu, H
Published in: J Vasc Interv Radiol
September 2024

PURPOSE: To estimate the risk of hepatobiliary infection, including endoTIPSitis, liver abscesses, and cholangitis, after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with prior biliary intervention. MATERIALS AND METHODS: This multi-institution, retrospective study identified 76 patients (n = 48 males; mean age, 54.9 years; mean Model for End-stage Liver Disease [MELD] score, 13.2; n = 45 for ascites and n = 23 for varices; n = 31 with prior liver transplantation) among 2,130 (3.6%) undergoing TIPS creation who had prior biliary intervention (n = 19 bilioenteric anastomoses, n = 35 sphincterotomies, n = 28 internal plastic stent placements, n = 4 internal metal stent placements, and n = 6 percutaneous biliary drain placements). The baseline risk of post-TIPS creation hepatobiliary infection was estimated from a control group of 1,202 TIPS creation procedures in patients without prior biliary intervention. RESULTS: Eleven (14.5%) of 76 patients developed hepatobiliary infection after TIPS creation, including 7 with endoTIPSitis, 4 with hepatic abscesses, and 2 with cholangitis. The 30-day risk of infection was 10.9% (95% confidence interval [CI], 3.5%-17.8%), significantly higher than the 0.4% risk (95% CI, 0.1%-0.8%) observed in patients without prior biliary intervention (hazard ratio [HR], 25.56; 95% CI, 8.36-78.13; P < .001). All types of biliary intervention were associated with increased risk of infection, with bilioenteric anastomoses conferring the highest risk. Paradoxically, among patients with prior biliary intervention, use of postprocedural antibiotic prophylaxis was associated with an increased infection risk (HR, 19.85; 95% CI, 2.44-161.50; P = .005). Microbial culture data showed high rates of Enterococcus, Klebsiella, and Candida species. CONCLUSIONS: Prior biliary intervention was associated with a 10.9% risk of hepatobiliary infection, including endoTIPSitis, liver abscess, and cholangitis, within 30 days after TIPS creation.

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Published In

J Vasc Interv Radiol

DOI

EISSN

1535-7732

Publication Date

September 2024

Volume

35

Issue

9

Start / End Page

1323 / 1331.e3

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stents
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
 

Citation

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Ronald, J., Bartlett, D., Border, L., Fickert, J., Gaba, R. C., Kim, J., … Yu, H. (2024). Hepatobiliary Infection after Transjugular Intrahepatic Portosystemic Shunt Creation in Patients with Prior Biliary Intervention: A Multi-Institution Retrospective Study. J Vasc Interv Radiol, 35(9), 1323-1331.e3. https://doi.org/10.1016/j.jvir.2024.06.009
Ronald, James, David Bartlett, Lloyd Border, Jaclyn Fickert, Ron C. Gaba, Jason Kim, Ali Kord, et al. “Hepatobiliary Infection after Transjugular Intrahepatic Portosystemic Shunt Creation in Patients with Prior Biliary Intervention: A Multi-Institution Retrospective Study.J Vasc Interv Radiol 35, no. 9 (September 2024): 1323-1331.e3. https://doi.org/10.1016/j.jvir.2024.06.009.
Ronald J, Bartlett D, Border L, Fickert J, Gaba RC, Kim J, et al. Hepatobiliary Infection after Transjugular Intrahepatic Portosystemic Shunt Creation in Patients with Prior Biliary Intervention: A Multi-Institution Retrospective Study. J Vasc Interv Radiol. 2024 Sep;35(9):1323-1331.e3.
Ronald, James, et al. “Hepatobiliary Infection after Transjugular Intrahepatic Portosystemic Shunt Creation in Patients with Prior Biliary Intervention: A Multi-Institution Retrospective Study.J Vasc Interv Radiol, vol. 35, no. 9, Sept. 2024, pp. 1323-1331.e3. Pubmed, doi:10.1016/j.jvir.2024.06.009.
Ronald J, Bartlett D, Border L, Fickert J, Gaba RC, Kim J, Kord A, Lokken RP, Patel M, Pollard B, Ramsey MT, Yu H. Hepatobiliary Infection after Transjugular Intrahepatic Portosystemic Shunt Creation in Patients with Prior Biliary Intervention: A Multi-Institution Retrospective Study. J Vasc Interv Radiol. 2024 Sep;35(9):1323-1331.e3.
Journal cover image

Published In

J Vasc Interv Radiol

DOI

EISSN

1535-7732

Publication Date

September 2024

Volume

35

Issue

9

Start / End Page

1323 / 1331.e3

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stents
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Nuclear Medicine & Medical Imaging
  • Middle Aged