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Predictors and Outcomes of Post-transjugular Intrahepatic Portosystemic Shunt Liver Failure in Patients with Cirrhosis

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Abstract

Background

Post-transjugular intrahepatic portosystemic shunt (TIPS) liver failure (PTLF) is a serious complication of TIPS procedure with poor patient prognosis. This study tried to investigate the incidence of PTLF following elective TIPS procedure and evaluated possible predictive factors for the same.

Methods

A retrospective analysis of patients who underwent elective TIPS placement between 2012 and 2022 and was conducted to determine development of PTLF (≥ 3-fold bilirubin and/or ≥ 2-fold INR elevation from the baseline) within 30 days following TIPS procedure. Medical record review was done and factors predicting development of PTLF and the 90-day transplant-free survival was determined.

Results

Thirty of 352 (8.5%) patients developed PTLF within 30 days of TIPS (mean age 54.2 ± 9.8 years, 83% male). The etiology of cirrhosis was related to non-alcoholic steatohepatitis (NASH) in 50%, alcohol in 33.3%, and hepatitis B/C virus infection in 16.7% of the patients. The mean Child–Turcotte–Pugh (CTP) score was 9.5 ± 1.2 and mean model for end stage liver disease (MELD) score was 14.6 ± 4.5 at the time of admission in patients who developed PTLF. The indication for TIPS was recurrent variceal bleed in 50% (15 of 30) and refractory ascites in 46.7% (14 of 30) patients with PTLF.

Multivariate analysis identified prior HE (OR 6.1; CI 2.57–14.5, p < 0.0001) and higher baseline CTP score (OR 1.47; CI 1.07–2.04; p = 0.018) as predictors of PTLF. PTLF was associated with significantly lower 90-day transplant-free survival, as compared to patients without PTLF (40% versus 96%, p < 0.001).

Conclusion

Almost 10% of patients with cirrhosis develop post-TIPS liver failure and is associated with significant early mortality and morbidity. Higher baseline CTP score and prior HE were identified as predictors for PTLF.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

TIPS:

Transjugular intrahepatic portosystemic shunt

PTLF:

Post-TIPS liver failure

CTP:

Child–Turcotte–Pugh

MELD:

Model for end stage liver disease

NASH:

Non-alcoholic steatohepatitis

ISGLS:

International Study Group of Liver Surgery

HVOTO:

Hepatic vein outflow tract obstruction

HE:

Hepatic encephalopathy

AKI:

Acute kidney injury

INR:

International normalization ratio

AST:

Aspartate transaminase

ALT:

Alanine transaminase

ALP:

Alkaline phosphatase

GGT:

Gamma-glutamyl transferase

PSG:

Portosystemic gradient

PTFE:

Polytetrafluoroethylene

SD:

Standard deviation

IQR:

Interquartile range

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Author notes

  1. Amar Mukund and Ashish Aravind have contributed equally to this work.

Authors and Affiliations

  1. Department of Intervention Radiology, Institute of Liver and Biliary Sciences, New Delhi, India

    Amar Mukund, Ashish Aravind & Yashwant Patidar

  2. Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India

    Ankur Jindal, Harsh Vardhan Tevethia & Shiv K. Sarin

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  1. Amar Mukund
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  2. Ashish Aravind
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  3. Ankur Jindal
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  4. Harsh Vardhan Tevethia
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Contributions

AM contributed toward conceptualization, review and original draft preparation, Analysis, and editing of manuscript; AA contributed toward original draft preparation; and AJ, HVT, YP, and SKS contributed toward review and editing of manuscript.

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Correspondence to Ankur Jindal.

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Mukund, A., Aravind, A., Jindal, A. et al. Predictors and Outcomes of Post-transjugular Intrahepatic Portosystemic Shunt Liver Failure in Patients with Cirrhosis. Dig Dis Sci 69, 1025–1034 (2024). https://doi.org/10.1007/s10620-023-08256-x

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