Author information

• ¹Department of Vascular and Interventional Radiology, Ghent University Hospital, Belgium;. Electronic address: Laurens.Hermie@uzgent.be.
• ²Department of Vascular and Interventional Radiology, Ghent University Hospital, Belgium.
• ³Department of Pediatrics, Ghent University Hospital, Belgium

Abstract

Purpose: To investigate the technical outcome, clinical outcome, and patency of transjugular intrahepatic portosystemic shunt (TIPS) in pediatric portal hypertension (PHT).

Methods: A systematic search of MEDLINE/PubMed, EMBASE, Cochrane databases and ClinicalTrials.gov, WHO ICTRP registries was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An a priori protocol was registered at the PROSPERO database. Original full-text articles on pediatric patients (sample size ≥ 5 patients with upper age limit of 21 years) and PHT undergoing TIPS creation for any indication were included.

Results: Seventeen 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%CI, 88.5% - 97.1%) of patients with a major complication 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 rate was respectively 61.8% (95%CI: 50.0 - 72.4) and 99.8% (95%CI: 96.2% - 100.0%). 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 respectively 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 ≥ 12 years.

Conclusions: This 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.