TIPS Insertion Research Articles

Soluble urokinase plasminogen activator receptor levels predict survival in patients with portal hypertension undergoing TIPS

Transjugular intrahepatic portosystemic shunt (TIPS) is the most effective therapy for complications of portal hypertension. However, clinical outcomes following TIPS placement vary widely between patients and identifying ideal candidates remains a challenge. Soluble urokinase plasminogen activator receptor (suPAR) is a circulating marker of immune activation that has previously been associated with liver inflammation, but its prognostic value in patients receiving TIPS is unknown. In the present study, we evaluated the potential clinical relevance of suPAR levels in patients undergoing TIPS insertion. suPAR concentrations were measured by ELISA in hepatic vein (HV) and portal vein (PV) blood samples from 99 patients (training cohort) as well as peripheral venous blood samples from an additional 150 patients (validation cohort) undergoing TIPS placement. The association between suPAR levels and patient outcomes was assessed using Kaplan-Meier methods and Cox-regression analyses. suPAR concentrations were significantly higher in HV samples compared to PV samples and correlated with PV concentration, the presence of ascites, renal injury, and consequently with the Child-Pugh and MELD scores. Patients with lower suPAR levels had significantly better short- and long-term survival after TIPS insertion, which remained robust after adjustment for confounders in multivariate Cox-regression analyses. Sensitivity analysis showed an improvement in risk prediction in patients stratified by Child-Pugh or MELD scores. In an independent validation cohort, higher levels of suPAR predicted poor transplant-free survival after TIPS, particularly in patients with Child-Pugh A/B cirrhosis. suPAR is largely derived from the injured liver and its levels are predictive of outcome in patients undergoing TIPS. suPAR, as a surrogate of hepatic inflammation, may be used to stratify care in patients following TIPS insertion. Transjugular intrahepatic portosystemic shunt (TIPS) is the most effective therapy for complications of portal hypertension. However, clinical outcomes following TIPS placement vary widely between patients and identification of the ideal candidates remains challenging. We show that soluble urokinase plasminogen activator receptor (suPAR), a circulating marker of immune activation that can easily be measured in routine clinical practice, is a novel marker to identify patients who will benefit from TIPS and those who will not.

Use and outcome of TIPS in hospitalized patients in Germany: A Nationwide study (2007-2018).

The number of complications in patients admitted for cirrhosis has increased over time. Portal hypertension is the driver of many complications of cirrhosis. TIPS placement is the most effective treatment of portal hypertension. The aim of this study was to analyze the use and impact of TIPS placement in the last decade in a nationwide study in Germany. We analyzed 14,598 admissions of patients for TIPS insertions in Germany from 2007 to 2018 using the DRG system, 12,877 out of 2,000,765 total admissions of patients with cirrhosis. All diagnoses and procedures were coded according to ICD-10-CM and OPS codes. The data were analyzed, focusing on the number of admissions and in-hospital mortality. The number of TIPS placements increased over the last decade. In-hospital mortality of cirrhotic patients with TIPS decreased when it was placed for severe bleeding (15.2% [TIPS] vs. 19.5% [endoscopy treatment]), ascites (8.7% [TIPS] vs. 14.4% [paracentesis]), and hepatorenal syndrome (HRS) (17.1% [TIPS] vs. 43.3% [no-TIPS]). In the case of bleeding, TIPS significantly decreased in-hospital mortality and also in ascites and HRS. During hospitalization, 22.6% admissions of patients with TIPS insertion showed HE. However, in-hospital mortality in patients admitted with HE grades 1 or 2 and TIPS was lower than in patients without TIPS. In the logistic regression, a higher HE grade(3 and 4), infection, and circulatory disease were found to be independently associated with in-hospital mortality in patients with TIPS insertion. Our nationwide study demonstrates that TIPS insertion is increasingly used in Germany. TIPS improves outcomes, especially in patients with ascites and HRS, regardless of lower HE grades, while higher HE grades, infection, and circulatory diseases seem to be associated with risk of in-hospital mortality.

Challenges in Diagnosis and Therapeutic Approach of Acute on Chronic Liver Failure-A Review of Current Evidence.

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute and severe decompensation of chronic liver disease (CLD) correlated with multiple organ failure, poor prognosis, and increased mortality. In 40-50% of ACLF cases, the trigger is not recognized; for many of these patients, bacterial translocation associated with systemic inflammation is thought to be the determining factor; in the other 50% of patients, sepsis, alcohol consumption, and reactivation of chronic viral hepatitis are the most frequently described trigger factors. Other conditions considered precipitating factors are less common, including acute alcoholic hepatitis, major surgery, TIPS insertion, or inadequate paracentesis without albumin substitution. Host response is likely the primary factor predicting ACLF severity and prognosis, the host immune response having a particular significance in this syndrome, together with the inflammatory cascade. The management of ACLF includes both the prevention of the precipitating factors that lead to acute liver decompensation and the support of vital functions, the prevention and management of complications, the estimation of prognosis, and the opportunity for liver transplantation.

Bevacizumab in combination with octreotide rescues a patient with liver cirrhosis, GAVE syndrome and refractory hemorrhage - a case report.

Gastric antral vascular ectasia (GAVE) syndrome is a rare but often challenging etiology of upper gastrointestinal bleeding (UGIB).We report on a 60-year-old patient with liver cirrhosis, GAVE syndrome and recurrent and refractory GAVE-related UGIB. During a 5-month hospital stay, the patient required a total of 82 packed red blood cells (pRBCs) and 23 gastroscopies. All endoscopic approaches, including multiple argon plasma coagulation and band ligation sessions, remained unsuccessful. Antrectomy was waived because of the high perioperative mortality risk in Child-Pugh B liver cirrhosis. TIPS insertion also failed to control the bleeding. Only continuous intravenous octreotide infusion slowed the bleeding, but this forced the patient to be hospitalized. After 144 inpatient days, administration of subcutaneous octreotide allowed the patient to be discharged. However, the patient continued to require two pRBCs every 2-3 weeks. Based on recently published data, we treated the patient with bevacizumab (anti-VEGF antibody) off-label at a dose of 7.5 mg/kg body weight every three weeks in nine single doses over six months. Since the first administration, the patient has remained transfusion-free, has not required hospitalization, and leads an active life, working full-time. He remains on octreotide, which has been reduced but not yet discontinued. Additionally, no adverse events were observed.Thus, in patients with liver cirrhosis and refractory GAVE-related hemorrhage, bevacizumab combined with subcutaneous octreotide should be considered as an effective and durable pharmacological treatment option.

FRI519 - Are psychometric tests helpful for the prediction of hepatic encephalopathy after TIPS insertion?

FRI519 - Are psychometric tests helpful for the prediction of hepatic encephalopathy after TIPS insertion?

FRI485 - TIPS insertion leads to partial reversal of systemic inflammation in patients with decompensated liver cirrhosis

FRI485 - TIPS insertion leads to partial reversal of systemic inflammation in patients with decompensated liver cirrhosis

Diastolic Dysfunction Is a Predictor of Poor Survival in Patients with Decompensated Cirrhosis.

Background Left ventricular diastolic dysfunction (LVDD) appears to be the earliest cardiac disturbance in cirrhosis patients. There are many previous reports reporting the significance of severity of LVDD on the outcome of liver transplantation or TIPS insertion, a few Indian studies have addressed the role of LVDD on survival in decompensated cirrhosis. The objective of this study is to assess the effect of LVDD on the survival of decompensated cirrhotic patients. Methods We prospectively evaluated 92 decompensated cirrhotic patients from April 2015 to March 2017 at IMS and SUM Hospital, Bhubaneswar, India. 2D echocardiography with tissue Doppler imaging was used to evaluate cardiac function, as per the American society of echocardiography guidelines. The primary endpoint was to evaluate the effect of LVDD on overall mortality. Results Ninety-two decompensated cirrhotic patients were evaluated in this prospective cohort study. Twenty-eight out of 92 patients (30%) died due to liver-related complications after a follow-up of 24 months. The decompensated cirrhotic patients with MELD score ≥ 15 had a significantly higher E/e′ ratio (11.94 ± 4.24 vs. 8.74 ± 3.32, p < 0.001) suggesting severe LV dysfunction in advanced cirrhosis. Patients with E/e′ ratio > 10 had significantly higher MELD score and Child-Pugh score (19.88 ± 7.72 vs. 14.31 ± 5.83; 10.25 ± 1.74 vs. 9.02 ± 1.74, p < 0.01, respectively) as compared to theE/e′ ratio < 10 group. In Cox proportional hazard multivariate analysis, E/e′ ≥ 10 (HR 2.72, 95% CI 1.07-6.9, p = 0.03) and serum albumin (HR 0.32, 95% CI 0.14-0.7, p < 0.01) were found to be independent predictors of mortality in decompensated cirrhotic patients. Conclusion: The presence of LVDD and low serum albumin were independent predictors of mortality in decompensated cirrhotic patients. Hence, LVDD is an indicator of advanced cirrhosis and mortality.

Role of circulating angiogenin levels in portal hypertension and TIPS.

BackgroundPathogenesis of portal hypertension is multifactorial and includes pathologic intrahepatic angiogenesis, whereby TIPS insertion is an effective therapy of portal hypertension associated complications. While angiogenin is a potent contributor to angiogenesis in general, little is known about its impact on TIPS function over time.MethodsIn a total of 118 samples from 47 patients, angiogenin concentrations were measured in portal and inferior caval vein plasma at TIPS insertion (each blood compartment n = 23) or angiographic intervention after TIPS (each blood compartment n = 36) and its relationship with patient outcome was investigated.ResultsAngiogenin levels in the inferior caval vein were significantly higher compared to the portal vein (P = 0.048). Ten to 14 days after TIPS, inferior caval vein angiogenin level correlated inversely with the portal systemic pressure gradient (P<0.001), measured invasively during control angiography. Moreover, patients with TIPS revision during this angiography, showed significantly lower angiogenin level in the inferior caval vein compared to patients without TIPS dysfunction (P = 0.01).ConclusionIn cirrhosis patients with complications of severe portal hypertension, circulating levels of angiogenin are derived from the injured liver. Moreover, angiogenin levels in the inferior caval vein after TIPS may predict TIPS dysfunction.

Impact of TIPS on Splenic Volume and Thrombocytopenia.

OBJECTIVE. Splenomegaly and thrombocytopenia are common complications in patients with cirrhosis. The present study aimed to evaluate changes in splenic volumes and platelet counts after TIPS insertion. MATERIALS AND METHODS. A total of 104 patients who had a diagnosis of portal hypertension and had undergone TIPS placement between November 2015 and August 2019 were enrolled in this retrospective cohort study. We retrospectively calculated splenic volumes before TIPS placement and at 1-2 and 6-12 months after TIPS placement and monitored the platelet count at 1, 3, 6, and 12 months after TIPS placement. RESULTS. The mean (± SD) portal pressure gradient before TIPS placement was 28.3 ± 4.6 mm Hg; after TIPS placement, it was 11.3 ± 4.5 mm Hg (p < .001). The mean splenic volume of all 104 patients before TIPS placement was 868 ± 409 cm3, and at 1-2 months after TIPS placement, it was 710 ± 336 cm3 (p < .001). Among the 43 patients for whom splenic volume data were available at both 1-2 and 6-12 months after TIPS placement, the mean splenic volume decreased from 845 ± 342 cm3 to 691 ± 301 cm3 and then to 674 ± 333 cm3, respectively. Correspondingly, the number of patients with severe thrombocytopenia decreased from 25 patients (35.7%) before the TIPS procedure to 16 patients (22.9%) in the 1-2 months after TIPS placement and then to 11 patients (15.7%) in the 6-12 months after TIPS implantation. The increase in the platelet count was significantly correlated with decreasing splenic volume (r2 = 0.3735; p < .001). CONCLUSION. In most patients, TIPS placement resulted in a significant decrease in splenic volume and a significant increase in the platelet count during the same period.

Transjugular intrahepatic portosystemic shunt is an effective and safe treatment of cirrhotic patients with portal vein thrombosis or cavernoma

TIPS is a well established treatment in selected patients with refractory ascites and/or gastrointestinal bleeding (GIB). Whether TIPS may also be a safe and effective therapeutic option for cirrhotic patients with chronic portal vein thrombosis (PVT) or cavernoma is still not clear. We Investigated the feasibility, safety and efficacy of TIPS in cirrhotic patients with PVT. All consecutive patients with PVT or cavernoma undergoing TIPS placement from April 2014 to April 2019 in GOM Niguarda are here considered. All patients completed at least 6 months of follow-up after TIPS. Of 153 patients undergoing TIPS insertion, 50(32%) had cirrhosis complicated by PVT or cavernoma. In 11 cases(22%) PVT was associated with GIB, in 16 (32%) with ascites. 32(64%) patients had failed recanalization while on anticoagulation, 18 could not be anticoagulated for contraindications. Majority of patients was male (72%), leading etiologies were post-viral and post-alcohol cirrhosis. Median age was 57 years. Median MELD was 14 (range 8–18). TIPS placement was technically feasible in 96%(48/50)of patients. PVT extension is described in table 1. Trans-splenic approach was necessary in 8/50(16%). Early post-TIPS complications were: hemoperitoneum (3 cases,6%), sovra-hepatic vein occlusion (1 case,2%) and systemic infection (6 cases, 12%). During follow-up 94%(15/16) recovered ascites and 15 patients(30%) had at least 1 portosystemic-encephalopathy episode; 33/48 (68%) patients had a complete recanalization and 11/48 (22%) had a partial recanalization. Liver related mortality was 6%. 18 patients were listed to transplantation after achieving portal patency, 6 have been already transplanted, 8 are on waiting list and 4 could be delisted for clinical improvement. TIPS in cirrhotic patients with PVT with or w/o cavernoma is effective and well tolerated. Complete recanalization was achieved in 2 patients out of three, obtaining a clinical beneficial effect on symptomatic PH. Recanalization allowed patients to be listed for LT when needed

2224 A Rare Complication of Post-TIPS Related Acute Cholecystitis

INTRODUCTION: Amongst the well documented TIPS-related biliary complications, there has been no reported case of acute cholecystitis. Multiple multicenter RCT comparing TIPS to large volume paracentesis reported better control of ascites, lower diuretic doses or cessation of diuretics in approximately 75% of the patients. Biliary related complications include biliary venous fistulas, biloma or biliary occlusion secondary to biliary compression. This may be the first reported case of Post TIPS acute cholecystitis. CASE DESCRIPTION/METHODS: 67-year-old white male with end-stage NASH cirrhosis was hospitalized 6 months ago for diuretic-resistant ascites. Prior to admission, he has required weekly large volume paracentesis. While hospitalized, he underwent large-volume paracentesis and was treated for acute urinary tract infection. TIPS was placed two weeks post discharged and ascites improved. Three days later while undergoing further evaluation, a liver ultrasound showed gall bladder wall thickening and gall stones, suggestive of acute cholecystitis with cholelithiasis. He subsequently developed severe pancytopenia and worsening liver function test. A percutaneous cholecystostomy tube was placed for gall bladder decompression along with a 14-day course of IV antibiotics. He later developed Choledocholithiasis and required ERCP and cholangioscopy. Multiple stones were extracted from the bile duct and complete fibrosis of the cystic duct was noted. The patient required multiple hospitalizations since then, frequent paracentesis and treatment for SBP. He recently underwent OLT with cholecystectomy which was technically challenging. DISCUSSION: TIPS insertion has been established as an effective second-line treatment for refractory ascites. There are 3 documented category of TIPS complications; technical, portosystemic and unique shunt related but no known reported case of acute cholecystitis. Hepatic encephalopathy occurs in approximately 30% of patients, early thrombosis or delayed shunt stenosis occurred in 22- 50% of patients prior to the development of polytetrafluoroethylene-covered stents. The technical intricacy of this intervention poses a potential risk, and morbidity rates as high as 20%. A broad understanding of the uncommon and unique complications can potentially decrease post-op-related complications especially in a patient undergoing OLT It is necessary for clinicians who perform this procedure to be aware of the clinical spectrum of TIPS-related complications and their management.

Nodular Regenerative Hyperplasia

A 38-year-old man with a history of two kidney transplants as well as genotype 3A hepatitis C virus (HCV) without cirrhosis presented with hematemesis. The patient was a nonresponder to pegylated IFN and ribavirin. A transjugular liver biopsy 2 years prior revealed stage 0 fibrosis without portal hypertension (HVPG=2 mm Hg). The patient completed a 12-week course of daclatasvir, sofosbuvir, and ribavirin, and achieved viral eradication with SVR12. Following HCV eradication, the patient developed new-onset ascites. Abdominal ultrasound revealed nodular-appearing liver and moderate ascites. Diagnostic paracentesis showed SAAG > 1.1 with low total protein (< 1.0 g/dL) and no evidence of SBP. He presented after one episode of hematemesis and was found to have a hemoglobin of 6.7 g/dL (baseline 10 g/dL). Emergent EGD revealed new medium-sized esophageal varices that were banded. Despite octreotide infusion, he developed recurrent hematemesis on hospital day 2. Repeat EGD revealed evidence of recurrent variceal bleeding. Liver biopsy demonstrated sinusoidal portal hypertension (HVPG=13 mm Hg) and nodular regenerative hyperplasia of the liver. He underwent TIPS insertion for recurrent variceal bleed with significant reduction in portal pressure gradient and resolution of bleeding. Nodular regenerative hyperplasia (NRH) is a form of noncirrhotic portal hypertension (NCPH). Histologically, NRH is distinguished from other causes of NCPH by diffuse parenchymal regenerative nodules and an absence of or minimal fibrosis in the perisinusoidal/periportal regions. The exact pathophysiology is not clearly defined; however, a generally accepted hypothesis involves hepatocyte hyperplasia in response to chronic inflammation, vascular disease, or direct endothelial injury from drugs, autoantibodies, T-cells, malignancies, or viruses. Development of NRH typically occurs within 1 to 6 years of insult, with some cases reporting development of NRH as early as 5-6 months after exposure toxic agents (i.e. azathioprine, oxaliplatin). Treatment involves avoiding and/or discontinuing offending agents and management of portal hypertension. While NRH is a rare but known complication of solid organ transplantation, it has yet to be reported following successful HCV therapy with direct-acting antiviral agents. In conclusion, we report a novel case of clinically significant NCPH secondary to NRH that developed in a kidney transplant recipient immediately following eradication of HCV.

TIPS and HCC: friends or foes?

Portal hypertension and hepatocellular carcinoma [HCC] are major complications of liver cirrhosis and may coexist in the same patient. Transjugular intrahepatic portosystemic shunt [TIPS] is an effective treatment for recurrent variceal bleeding and refractory ascites although accumulating evidence has shown that its indication is gradually expanding. TIPS placement reduces portal flow by connecting splanchnic vessels to systemic circulation. As a consequence parenchymal portal venous flow is decreased so inducing an ischemic injury. In this condition, a possible activation of hepatic stellate cells, an induction of neoangiogenesis and an increase in secretion of HGF and VEGF may represent possible triggers for hepatocarcinogenesis. On these bases, several studies have explored a possible influence of TIPS on the onset of hepatocellular carcinoma [HCC] in cirrhotic patients. To date the results are controversial and the role of TIPS as risk factor for HCC is still unclear. Moreover, the diversion of portal flow and the onset of arterioportal shunts following TIPS insertion, may reduce the efficacy and the safety profile of transarterial treatments. Until now, very little evidence has been collected regarding this topic and the results are conflicting. Therefore, whether TIPS and hepatocellular carcinoma are either “Friends or Foes” is still an ongoing dilemma.

P541 QUERCETIN INDUCES HSC APOPTOSIS, UP-REGULATION OF CB2 AND DOWN-REGULATION OF CB1 IN AN ANIMAL MODEL OF LIVER FIBROSIS

gradient (HVPG) was 21mmHg (17, 25). After TIPS insertion, median HVPG was 9mmHg (6, 10). Group A patients had a higher right atrial pressure (RAP) [10 (5.0, 10.0) vs 5.0 (4.0, 10.0) mmHg, p 0.001] and pulmonary arterial systolic pressure (PASP) [37.0 (31.0, 45.0) vs. 32.0 (26.0, 39.2) mmHg, p < 0.001) after TIPS insertion when compared to Group B patients. Adjusting for confounders failed to attenuate these differences. Conclusions: Patients with cirrhosis undergoing TIPS insertion had a significant change in PASP and RAP, likely reflective of the heart’s inability to handle volume overload. Elevated PASP and RAP may raise concern about LT candidacy.

8:18 AM; Abstract No. 167 - TIPS insertion at the portal vein bifurcation with the viatorr stent-graft: incidence of hemorrhagic complications

TIPS insertion through the extrahepatic portion of the right or left portal veins has traditionally been thought to be high risk for hemorrhagic complications, due to the lack of adjacent liver parenchyma to provide a seal. However, with the ubiquitous use of stent grafts for TIPS creation, the risk may be considerably less. The purpose of this project was to determine the incidence of hemorrhagic complications after TIPS insertion at the portal vein bifurcation compared to insertion at the intrahepatic portions of the portal veins.

8:54 AM; Abstract No. 171 - Impact of TIPS insertion on hepatic functional status

While poor hepatic functional reserve has been shown to correlate with poor post-TIPS outcomes, the actual impact of TIPS insertion on hepatic function is not well understood. TIPS insertion often results in decreased portal perfusion, which. The purpose of this study is to identify which factors correlate with hepatic function after TIPS insertion.

Soluble TNF-Alpha-Receptors I Are Prognostic Markers in TIPS-Treated Patients with Cirrhosis and Portal Hypertension

BackgroundTNFα levels are increased in liver cirrhosis even in the absence of infection, most likely owing to a continuous endotoxin influx into the portal blood. Soluble TNFα receptors (sTNFR type I and II) reflect release of the short-lived TNFα, because they are cleaved from the cells after binding of TNFα. The aims were to investigate the circulating levels of soluble TNFR-I and -II in cirrhotic patients receiving TIPS.MethodsForty-nine patients with liver cirrhosis and portal hypertension (12 viral, 37 alcoholic) received TIPS for prevention of re-bleeding (n = 14), therapy-refractory ascites (n = 20), or both (n = 15). Portal and hepatic venous blood was drawn in these patients during the TIPS procedure and during the control catheterization two weeks later. sTNFR-I and sTNFR-II were measured by ELISA, correlated to clinical and biochemical characteristics.ResultsBefore TIPS insertion, sTNFR-II levels were lower in portal venous blood than in the hepatic venous blood, as well as in portal venous blood after TIPS insertion. No significant differences were measured in sTNFR-I levels. Hepatic venous levels of sTNFR-I above 4.5 ng/mL (p = 0.036) and sTNFR-II above 7 ng/mL (p = 0.05) after TIPS insertion were associated with decreased survival. A multivariate Cox-regression survival analysis identified the hepatic venous levels of sTNFR-I (p = 0.004) two weeks after TIPS, and Child score (p = 0.002) as independent predictors of mortality, while MELD-score was not.ConclusionHepatic venous levels of sTNFR-I after TIPS insertion may predict mortality in patients with severe portal hypertension.

No difference in portal and hepatic venous bacterial DNA in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt insertion

Bacterial translocation (BT) with immune activation may lead to hemodynamical alterations and poor outcomes in patients with cirrhosis. We investigated bacterial DNA (bDNA), a marker of BT, and its relation to portal pressure and markers of inflammation in the portal and hepatic veins in patients with cirrhosis undergoing TIPS insertion. We analysed plasma for bDNA and markers of inflammation in 28 patients [median portal pressure gradient 15 (11-19) mmHg] during TIPS treatment for refractory ascites (n=19) or acute variceal bleeding (n=9). Advanced cirrhosis was present in the majority [Child-Pugh class (A/B/C): 1/14/13], and most often caused by alcohol (n=21). bDNA was detectable in one or both samples in 16 of 28 patients (57%). bDNA was present in 39% of the samples from the portal vein vs 43% of the samples in the hepatic vein (P=0.126). Antibiotics had no effect on bDNA or markers of inflammation. Markers of inflammation did not differ between the hepatic and portal veins with the exceptions of soluble urokinase plasminogen activating receptor (suPAR) and vascular endothelial growth factor (VEGF), both higher in the hepatic vein (P=0.031 and 0.003 respectively). No transhepatic gradient of bDNA was evident, suggesting that no major hepatic elimination of bDNA occurs in advanced liver disease. bDNA, in contrast to previous reports was largely unrelated to a panel of markers of inflammation and without relation to portal pressure.

PWE-123 Predictors Of Hepatic Encephalopathy and Mortality Following Tips Insertion for Refractory Ascites

IntroductionTransjugular intrahepatic portosystemic shunt (TIPS) insertion has been used for over twenty years to treat the complications of portal hypertension. TIPS insertion provides better control of refractory ascites than large...

PTU-054 Transjugular intrahepatic portosystemic shunts following liver transplantation can be associated with a good prognosis: a single centre experience

IntroductionTransjugular intrahepatic portosystemic shunt (TIPS) is indicated in the management of portal vein thrombosis or stenosis, portal hypertension and for veno-occlusive disease in post-liver transplant (LT) patients. Previous series have...