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Semin Liver Dis 2018; 38(01): 087-096
DOI: 10.1055/s-0038-1627457
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Does Transjugular Intrahepatic Portosystemic Shunt Stent Differentially Improve Survival in a Subset of Cirrhotic Patients?

Jonel Trebicka
1   Department of Internal Medicine I, University of Bonn, Bonn, Germany
2   European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
› Author Affiliations
Funding The author has received grants and/or honoraria from Alexion, Bayer, BMS, Falk Pharma, Gilead, Grifols, Sequana Medical, and W.L. Gore & Associates. The author is supported by Deutsche Forschungsgemeinschaft (SFB-TRR57 P18), Cellex Foundation, and the European Union's Horizon 2020 Research and Innovation Program (No 668031).
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Publication Date:
22 February 2018 (online)

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Abstract

Does transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment. While TIPS does not improve survival in other situations, it improves disease management, especially in patients without TIPS contraindications but with refractory bleeding, early rebleeding, portal vein thrombosis, and hepatorenal syndrome. Experience gained at the centers and follow-up of TIPS patients are key features that improve outcome. Important factors for selection and follow-up include cardiac function, inflammation, sarcopenia, age, and early evaluation for liver transplantation.

Keywords

variceal bleeding - refractory ascites - portal hypertension - systemic inflammation - sarcopenia