TIPS Modification in the Management of Shunt-Induced Hepatic Encephalopathy: Analysis of Predictive Factors and Outcome with Shunt Modification

• Main Authors: Philipp Schindler, Leon Seifert, Max Masthoff, Arne Riegel, Michael Köhler, Christian Wilms, Hartmut H. Schmidt, Hauke Heinzow, Moritz Wildgruber
• Format: Article
• Language: English
• Published: MDPI AG 2020-02-01
• Series: Journal of Clinical Medicine
• Subjects: hepatic encephalopathy; portasystemic shunt; transjugular intrahepatic; liver cirrhosis
• Online Access: https://www.mdpi.com/2077-0383/9/2/567

Purpose: To evaluate predictive parameters for the development of Hepatic Encephalopathy (HE) after Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement and for success of shunt modification in the management of shunt-induced HE. Methods: A retrospective analysis of all patients with TIPS (<i>n</i> = 344) has been performed since 2011 in our university liver center. <i>n</i> = 45 patients with HE after TIPS were compared to <i>n</i> = 48 patients without HE after TIPS (case-control-matching). Of <i>n</i> = 45 patients with TIPS-induced HE, <i>n</i> = 20 patients received a reduction stent (<i>n</i> = 18) or TIPS occlusion (<i>n</i> = 2) and were differentiated into responders (improvement by at least one HE grade according to the West Haven classification) and non-responders (no improvement). Results: Older patient age, increased serum creatinine and elevated International Normalized Ratio (INR) immediately after TIPS placement were independent predictors for the development of HE. In 11/20 patients (responders, 55%) undergoing shunt modification, the HE grade was improved compared with nine non-responders (45%), with no relevant recurrence of refractory ascites or variceal bleeding. A high HE grade after TIPS insertion was the only positive predictor of treatment response (<i>p</i> = 0.019). A total of 10/11 responders (91%) survived the 6 months follow-up after modification but only 6/9 non-responders (67%) survived. Discussion: Older patient age as well as an increased serum creatinine and INR after TIPS are potential predictors for the development of HE. TIPS reduction for the treatment of TIPS-induced HE is safe, with particular benefit for patients with pronounced HE.