Pre-existing Hepatic Encephalopathy: Really a Contraindication to Elective TIPS?

• Published in: Cardiovascular and interventional radiology 2024, Vol.47 (1), p.69-77
• Main Authors: Torkian, Pooya, Wallace, Stephanie, Lim, Nicholas, Flanagan, Siobhan, Golzarian, Jafar, Young, Shamar J.
• Format: Article
• Language: English
• Subjects: Ascites; Cardiology; Clinical Investigation; Contraindications; Health care expenditures; Hepatic encephalopathy; Hepatic Encephalopathy - etiology; Hospitals; Humans; Hypertension; Hypertension, Portal; Imaging; Liver; Liver Cirrhosis; Medicine; Medicine & Public Health; Mortality; Nuclear Medicine; Observational studies; Patient admissions; Patients; Placement; Portasystemic Shunt, Transjugular Intrahepatic; Quality of life; Radiology; Regression analysis; Retrospective Studies; Statistical analysis; Survivability; Survival; TIPS; Transplants & implants; Treatment Outcome; Ultrasound
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-023-03566-z

Purpose To evaluate the impact of pre-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) on developing post-TIPS HE. Materials and Methods In this retrospective, single center observational study, all patients who underwent successful TIPS placement between January 2005 and May 2020 with data pertaining to HE in their chart were included. Patient demographics and procedural details were recorded. Clinical outcomes post-TIPS, were collected and compared across patients with and without pre-TIPS HE. Results Of 326 included patients, 159 (159/326, 48.8%) had a history of pre-TIPS HE. In total those without a history of HE were more likely to develop HE during follow up (136 (136/167, 81.4%) vs 107 (107/159, 67.3%), p  = 0.001). When evaluating for predictors of developing HE within 3 months of TIPS placement, no significant variables were found on logistic regression, including prior history of HE (HR 1.16 (95% CI 0.73–1.84), p  = 0.529). Univariate and multivariate regression analysis, however, showed that a history of HE was predictive of developing HE at any point in the follow-up period ( p  = 0.002 and p  = 0.008, respectively). However, on Kaplan–Meier analysis no significant difference in the development of HE ( p  = 0.574) or hospital admission for HE ( p  = 0.554) post-TIPS was seen between patients with and without pre-TIPS HE. Additionally, there was no difference in 3-month survival ( p  = 0.412) or overall survival post-TIPS survival ( p  = 0.798). Conclusion Pre-TIPS HE did not predict the development of HE within 3 months of TIPS. Outcomes such as hospital admission and survivability were not different between patients with and without prior HE.