Percutaneous shunt reduction for the management of TIPS-induced acute liver decompensation: A follow-up study

Abstract

Background and rationale for the study. The purpose of this study was to assess the technical and clinical outcomes of transjugular intrahepatic porto systeic shunt (TIPS) reduction for the management of TIPS-induced acute liver decompensation. Between August 2000 and Novomber 2013, 347 patients underwent a TIPS procedure in the authors institution; 21/347 (6%) developed post-TIPS acute liver decompensation which was managed using a percutaneous shunt reduction technique. patient demographics. laboratory tests before and after initial TIPs and TIPS reduction, procedural dataand clinical follow-up data were anlysed. Results. Twenty-one patients (mean age 63 years) who underwent an initial TIPS procedure for variceal bleeding (n = 7; 33%) or refractory ascites (n - 14; 67%) successfully underwent reduction ten days (3-34days) after the initial TIPS procedure. The portosystemic pressure gradient (PSPG) increased from 8 (3-17) mmHg before reduction to 12 (7-23) mmHg after shunt reduction. survial at one and six months follow-up was 15 (71%) and 11 patients (52%) respectively. The international normalised ratio (INR) (1.7 vs 1.5; p = 0.044) was significantly different after TIPS reduction in the non-survial group compared to the survial group. in Conculusion. TIPS reduction for the management of TIps-induced acute liver decompensation is technically feasible and is associated with a one and six month mortality rate of 29% and 48% respectively.Higher post-TIPS-reduction INR values may be asssociated with higher risk of early mortality.