Oral Direct-acting antivirals (DAAs) are safe, highly effective altering disease burden and prognosis in hepatitis C patients. Sustained virologic response (SVR) is achieved nowadays in more than 90% of the treated patients and related to the improvements in functions of the liver, fibrosis plus survival. Furthermore, portal hypertension is

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Background: Hepatic encephalopathy (HE) is one of the serious complications observed post-TIPS operations in patients with different complications of portal hypertension such as refractory ascites, refractory hydrothorax, bleeding varices, and hepato-renal syndrome. Herein, we aimed to clarify predisposing factors for post-TIPS incidence of HE according to pre-TIPS hemodynamics. Results: Fifty patients were enrolled in this study with different complications of portal hypertension; most of them have Child A and B scores. Patients were evaluated by ultrasound Doppler for the flow inside the portal vein and clinically recorded into two groups: group 1, 31 patients with hepatopetal flow; and group 2, 19 patients with hepatofugal flow. Then, TIPS was performed and patients were reassessed 1 month later to detect HE. Multiple variables such as age, gender, etiology of liver disease, and indication for TIPS had no significant differences. The incidence of HE post-TIPS was observed more at group 1 more than at group 2 (P = 0.02). Conclusions: Post-TIPS incidence of HE was interestingly related to pre-TIPS flow in the portal vein (hepatopetal group more than hepatofugal group). Patients with hepatofugal flow in the portal vein are perfect candidate for TIPS than patients with hepatopetal flow in the portal vein. Patients with previous history of HE are contraindicated for TIPS except as a bridge for liver transplantation.