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Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
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Refractory Hepatic Encephalopathy After Elective Transjugular Intrahepatic Portosystemic Shunt: Risk Factors and
Michael W Rowley1,2, Myunghan Choi3, Steve Chen4,2
1Department of Internal Medicine, Banner University Medical Center Phoenix, Phoenix, AZ, USA.
Cardiovascular and Interventional Radiology
|June 7, 2018
Summary
Refractory hepatic encephalopathy (RHE) after transjugular intrahepatic portosystemic shunt (TIPS) revision occurs in 5.7% of patients. Predictors include larger shunt size, prior HE history, and low albumin, with high mortality despite improved RHE.
Area of Science:
- Hepatology
- Interventional Radiology
- Gastroenterology
Background:
- Hepatic encephalopathy (HE) is a frequent complication following transjugular intrahepatic portosystemic shunt (TIPS) placement.
- Refractory hepatic encephalopathy (RHE) necessitates TIPS revision, but its predictors and outcomes are not well-defined.
Purpose of the Study:
- To evaluate the incidence, predictors, and outcomes of post-TIPS RHE requiring TIPS revision.
- To identify patient and procedural factors associated with RHE development.
Main Methods:
- Retrospective cohort study of 174 patients undergoing elective TIPS placement.
- Evaluation of clinical demographics, procedural variables, and 1-year outcomes post-revision.
Main Results:
- 5.7% of patients (10/174) developed RHE requiring revision.
- Independent predictors of RHE included shunt size >8 mm, prior HE history, and serum albumin ≤2.5 g/dL.
- RHE improved in 80% of revised patients, but 1-year survival without liver transplantation was only 10%.
Conclusions:
- TIPS revision improves RHE in most patients but is associated with high long-term mortality, particularly in non-liver transplant candidates.
- Using shunt sizes <8 mm may reduce RHE risk in patients with a history of HE and low serum albumin.
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