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Updated: Sep 3, 2025

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
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Targeted decrease of portal hepatic pressure gradient improves ascites control after TIPS.

Alexander Queck1, Louise Schwierz2, Wenyi Gu1,3

  • 1Department of Internal Medicine 1 , University Hospital Frankfurt, Johann Wolfgang Goethe-University , Frankfurt am Main , Germany.

Hepatology (Baltimore, Md.)
|July 23, 2022
PubMed
Summary
This summary is machine-generated.

Achieving greater portal hepatic pressure gradient (PPG) reduction after transjugular intrahepatic portosystemic shunt (TIPS) insertion improves ascites control and survival in liver cirrhosis patients. Follow-up at 6 weeks is crucial for assessing ascites persistence.

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Area of Science:

  • Hepatology
  • Interventional Radiology
  • Gastroenterology

Background:

  • Ascites is a critical indicator of decompensated liver cirrhosis, often stemming from portal hypertension.
  • Transjugular intrahepatic portosystemic shunt (TIPS) insertion is a treatment for recurrent or refractory ascites.
  • Current guidelines lack specific targets for portal hepatic pressure gradient (PPG) reduction post-TIPS.

Purpose of the Study:

  • To investigate the correlation between PPG reduction after TIPS and ascites control.
  • To determine if PPG reduction influences patient survival in liver cirrhosis with ascites.
  • To identify predictors of ascites persistence or resolution post-TIPS.

Main Methods:

  • A retrospective analysis of 341 patients undergoing TIPS for ascites.
  • Invasive measurement of portal and inferior vena cava pressures during TIPS procedures.
  • Correlation of PPG changes with patient outcomes, ascites progression, and survival.

Main Results:

  • Greater PPG reduction post-TIPS was associated with better ascites control at 6 weeks (65% vs. 55% reduction).
  • Patients with resolved ascites at 6 weeks had significantly better survival rates (185 vs. 41 weeks).
  • Higher Child-Pugh score and lower serum sodium predicted ascites persistence, while PPG reduction predicted resolution.

Conclusions:

  • The degree of PPG reduction and the post-TIPS PPG level are linked to short-term ascites control and long-term survival.
  • A 6-week follow-up is recommended to evaluate ascites persistence after TIPS.
  • Optimizing PPG reduction during TIPS may improve outcomes for cirrhotic patients with ascites.