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Pre-existing Hepatic Encephalopathy: Really a Contraindication to Elective TIPS?

Pooya Torkian1, Stephanie Wallace2, Nicholas Lim3

  • 1Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA. Ptorkian@umn.edu.

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Summary

A history of hepatic encephalopathy (HE) before transjugular intrahepatic portosystemic shunt (TIPS) placement did not predict developing HE within three months post-procedure. Outcomes like hospital admission and survival rates were similar between patients with and without prior HE.

Keywords:
Hepatic encephalopathyPortal hypertensionPortal vein punctureTransjugular intrahepatic portosystemic shunt

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Area of Science:

  • Hepatology
  • Interventional Radiology
  • Gastroenterology

Background:

  • Hepatic encephalopathy (HE) is a common complication of liver disease.
  • Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to manage complications of portal hypertension.
  • The impact of pre-existing HE on post-TIPS HE development is not fully understood.

Purpose of the Study:

  • To evaluate the impact of pre-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) on the development of post-TIPS HE.
  • To identify predictors of post-TIPS HE development.
  • To compare clinical outcomes in patients with and without pre-TIPS HE.

Main Methods:

  • Retrospective, single-center observational study.
  • Included 326 patients who underwent successful TIPS placement between January 2005 and May 2020.
  • Compared clinical outcomes, including HE development, hospital admission, and survival, between patients with and without pre-TIPS HE.

Main Results:

  • 48.8% of patients had a history of pre-TIPS HE.
  • Patients without pre-TIPS HE were more likely to develop HE post-TIPS (81.4% vs 67.3%, p=0.001).
  • Pre-TIPS HE was not a significant predictor of HE development within 3 months post-TIPS on logistic regression (HR 1.16, p=0.529).
  • However, pre-TIPS HE was predictive of HE development at any point during follow-up (p=0.002).
  • No significant differences were observed in HE development, hospital admission for HE, 3-month survival, or overall survival between groups (p>0.05).

Conclusions:

  • Pre-TIPS HE does not predict the development of HE within 3 months after TIPS placement.
  • Clinical outcomes, including hospital admissions and survival, are similar for patients with and without pre-TIPS HE.
  • Further research may be needed to understand the long-term implications of pre-TIPS HE on post-TIPS outcomes.