Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Using Dedicated versus Generic...

To compare the incidence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) using two types of expanded polytetrafluoroethylene (ePTFE)-covered stents: dedicated stent-graft (DSG; Viatorr) versus generic stent-graft (GSG; Fluency) in patients with cirrhosis.

We conducted a retrospective analysis of cirrhotic patients who underwent TIPS using DSGs or GSGs between January 2012 and March 2024. Propensity score matching (PSM) was used to adjust for baseline differences between the two groups. The primary outcome was overt hepatic encephalopathy (OHE). Secondary outcomes included shunt dysfunction and transplant-free overall survival (TF-OS).

After matching, 320 patients were included in each group. The cumulative incidence of OHE at 1, 2, and 3 years was lower in the DSG group than in the GSG group (16.1%, 21.9%, and 26.3% vs. 26.6%, 31.3%, and 33.7%; p = 0.013). After adjustment for confounders, DSGs were independently associated with a lower risk of OHE (subdistribution hazard ratio [sHR], 0.68; 95% CI, 0.51-0.91). Shunt dysfunction was also less frequent in the DSG group (2.9%, 5.2%, and 6.8% vs. 9.8%, 18.2%, and 23.7%; p < 0.001), with DSGs independently associated with a reduced risk (sHR, 0.29; 95% CI, 0.18-0.48). TF-OS did not differ significantly between the DSG and GSG groups (88.8%, 82.5%, and 76.8% vs. 90.3%, 83.1%, and 76.1%; p = 0.979).

DSGs were associated with a lower risk of OHE and improved shunt patency compared with GSGs, supporting their preferential use in TIPS creation.