Liver stiffness in patients undergoing TIPS implantation

Aim: Besides fibrosis stage, liver stiffness (LS) is increased by various other conditions such as inflammation, perfusion or central venous pressure. We here study LS dynamics before and after TIPS implantation which is routinely used to lower the hepatic vein pressure gradient (HPVG).

Methods: 20 patients were enrolled (13 males, 7 females). No or no valid LS could be obtained in 5 patients. In the remaining 15 patients, indication for TIPS implantation were hepatorenal syndrome/refractory ascites, variceal bleeding or both in 7, 4, and 4 patients. LS (Fibroscan, XL probe) was measured 30 min before and after TIPS implantation. In addition, right-atrial, portal and venous pressure were recorded, and ultrasound and lab tests were performed.

Results: The following mean changes were observed after TIPS implantation for right atrial pressure, portal pressure and HPVG: 6.13, -5.47 and -11.60 mmHg. LS decreased in the overall population by 4.2 kPa. A significant mean decrease (p < 0.01) of LS from 52 to 38 kPa was observed in a majority of patients (n = 9, 60%) while LS increased from 49 to 65 kPa in four patients (26.6%). The change of LS was significantly (p < 0.05) correlated with the presence of ascites, a small spleen size, and reduced liver function (bilirubin, INR). In addition, post-TIPS LS was negatively correlated (p < 0.01) with serum sodium levels (r =-0.744) and weakly (p = 0.08) with portal pressure. Post-interventional right atrial pressure was associated with initial LS (p = 0.06). Longitudinal observation of up to four months after TIPS showed improvement in the majority of patients (81%). Only two had still significant ascites, one had deceased.

Conclusion: LS decreases in most patients after TIPS implantation namely in those with rather good liver function and pronounced water retention. Hydration status and portal pressure seem to be important additional determinants of LS.