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

  • Clinical Investigation
  • TIPS
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

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.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA

    Pooya Torkian, Stephanie Wallace, Siobhan Flanagan & Jafar Golzarian

  2. Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA

    Nicholas Lim

  3. Department of Medical Imaging, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, USA

    Shamar J. Young

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  1. Pooya Torkian
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  2. Stephanie Wallace
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Correspondence to Pooya Torkian.

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Torkian, P., Wallace, S., Lim, N. et al. Pre-existing Hepatic Encephalopathy: Really a Contraindication to Elective TIPS?. Cardiovasc Intervent Radiol 47, 69–77 (2024). https://doi.org/10.1007/s00270-023-03566-z

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  • DOI: https://doi.org/10.1007/s00270-023-03566-z

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