Shunt magnitude is a key determinant of overt hepatic encephalopathy in patients undergoing TIPS

作者：Davide Roccarina, Dario Saltini, Marco Senzolo, Silvia Nardelli, Martina Rosi, Valentina Adotti, Marcello Bianchini, Lara Biribin, Stefania Gioia, Cristian Caporali, Lucia Ragozzino, Tomas Guasconi, Margherita Falcini, Federico Casari, A. Piscopo, Francesco Pindozzi, Stefano Gitto, Silvia Aspite, Gianmarco Falcone, Angelica Ingravallo, Melania Gaggini, Kymentie Ferdinande, U. Arena, Manuela Merli, Lorenzo Ridola, Oliviero Riggio, Fabrizio Fanelli, Chiara Mangini, Fabio Marra, Sara Montagnese, Filippo Schepis, Francesco Vizzutti · 发表于：JHEP Reports · 年份：2025 · DOI：10.1016/j.jhepr.2025.101676 · 被引用次数：5 · 研究领域：Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes、Liver Disease Diagnosis and Treatment

Background & Aims: Under-dilated transjugular intrahepatic portosystemic shunts (U-TIPS) has been proposed to reduce the risk of overt hepatic encephalopathy (OHE) while effectively treating portal hypertension (PH) complications. In this study we assessed how end-procedural porto-caval pressure gradient (PCPG), obtained in sedated patients, and endoprosthesis dilation affect the risk of OHE after TIPS. Methods: Consecutive patients with cirrhosis receiving TIPS for refractory ascites or recurrent PH-related bleeding were enrolled. OHE within 1-year was analyzed using a competing risk model, accounting for death and liver transplantation. Adequate hemodynamic response (AHR) was defined as post-TIPS PCPG <12 mmHg or reduction ≥60% in refractory ascites, and <12 mmHg or reduction ≥50% in PH-related bleeding. PCPG values outside of the above criteria were considered as inadequate response. U-TIPS was defined as endoprosthesis dilation ≤7 mm, as opposed to standard TIPS (S-TIPS). Results: S-TIPS confirmed that AHR and PCPG <10 mmHg were not associated with OHE within either TIPS group. Conclusions: The magnitude of the shunt emerges as an independent key determinant of post-TIPS OHE. Impact and implications: TIPS carries a significant risk of overt hepatic encephalopathy. Low portosystemic pressure gradient and larger shunt diameter have been reported to increase the risk of overt hepatic encephalopathy. The TIPS dilation diameter represents an independent key determinant of post...