Liver stiffness measured by transient elastography as predictor of prognoses following portosystemic shunt occlusion

Abstract Background and Aim This study aimed to identify predictors of model for end‐stage liver disease sodium score reductions and improvements in vital prognoses following portosystemic shunt occlusion in portal hypertension patients. Methods Seventy cirrhotic patients with major portosystemic shunts and a mean model for end‐stage liver disease sodium score of 10.5 underwent balloon‐occluded retrograde transvenous obliteration between February 2008 and March 2017. We calculated the scores before and 1 month after shunt occlusion. The long‐term outcomes were monitored, and vital prognoses were analyzed. Results The model for end‐stage liver disease sodium score did not change significantly 1 month post‐balloon‐occluded retrograde transvenous obliteration, and the score decreased postoperatively in 31 (44.3%) patients. Univariate analyses showed that decline in the score after portosystemic shunt occlusion was strongly associated with hepatic encephalopathy as a procedural indication, lower liver volumes, and lower liver stiffness levels measured by transient elastography before treatment ( P < 0.05). Multivariate logistic regression analysis identified preoperative liver stiffness level as an independent predictor of model for end‐stage liver disease sodium score amelioration following balloon‐occluded retrograde transvenous obliteration ( P < 0.05), and receiver operating characteristic curve analysis determined a liver stiffness cutoff value of 21.6 kPa, with a sensitivity of 76.0% and specificity of 69.6%. The Kaplan–Meier method determined that overall survival rates after treatment in patients with liver stiffness < 21.6 kPa were significantly higher than in patients with liver stiffness ≥ 21.6 kPa ( P < 0.05). Conclusions Liver stiffness measured by transient elastography may predict improvements in model for end‐stage liver disease sodium scores and in survival rates after portosystemic shunt occlusion in portal hypertension patients.