Increase in liver stiffness after transjugular intrahepatic portosystemic shunt predicts mortality

Background and aims:

Transjugular intrahepatic portosystemic shunt (TIPS) efficiently treats complications of portal hypertension. However, patient selection remains challenging. Liver and spleen stiffness might predict clinically significant portal hypertension. This prospective multicenter study investigated liver stiffness in patients receiving TIPS regardless of indication.

Methods:

Of 83 included patients, 16 underwent TE immediately before and 30 minutes after TIPS (acute group), while 67 patients received shear wave elastography (SWE) of liver and spleen one day before and seven days after TIPS (chronic group) and followed further. In blood samples obtained before TIPS from cubital, portal and hepatic veins, interleukins (IL) (IL1b, IL6, IL8, IL10, IL18) and interferon gamma were analyzed.

Results:

In 27 patients (five acute, 22 chronic), it resulted in an increase in liver stiffness of more than 10%. In 56 patients, liver stiffness decreased or remained unchanged (< 10%). Importantly, spleen stiffness measured by SWE decreased in all patients (chronic group). None of the clinical or laboratory parameters differed between patients with increase in liver stiffness and those without. Of note, they showed higher overall and/or hepatic venous levels of proinflammatory cytokines at TIPS and higher incidence of organ failure and worse survival after TIPS. CRP values and increase of more than 10% in liver stiffness after TIPS were the only independent predictors of mortality in these patients.

Conclusions:

This study demonstrates for the first time that presence of systemic inflammation predisposes patients to develop increased liver stiffness after TIPS, a predictor of organ failure and death (NCT03072615).