The Relationship and Changes of Liver Blood Supply, Portal Pressure Gradient, and Liver Volume following TIPS in Cirrhosis

Abstract

Aim. Transjugular intrahepatic portosystemic shunt (TIPS) alters the liver blood supply and reduces portal pressure. This study was to investigate the changes and associations of the hepatic blood flow, liver volume, and portal pressure gradient (PPG) after TIPS in liver cirrhosis. Methods. Twenty-one patients with liver cirrhosis who received TIPS were recruited. The contrast CT images were used to assess the iodine density (ID) of liver parenchymal and liver volume. The ID of the liver parenchyma was used to reflect hepatic blood flow. We used a paired t-test and regression analysis to investigate the effect of TIPS on hepatic blood flow, liver volume, and PPG in individuals with cirrhosis and the factors that affect changes in liver volume. Results. After TIPS, there was a significant improvement in the ID of liver parenchyma at arterial phase (AP) and PPG in individuals with cirrhosis ( P < 0.05). Each 1 unit increase in the ID change of whole liver parenchyma at the venous phase (VP) was significantly associated with a 269.44 cm3 increase in the liver volume after TIPS (b = 269.44, P = 0.012). With an increasing ID change of whole liver parenchyma at VP, the change in liver volume followed an increasing trend ( P for overall association = 0.005). Conclusions. Our data indicate that there was a significant improvement in hepatic blood flow, especially at AP, after TIPS and the change in hepatic blood supply from the portal vein is positively associated with the change in liver volume after TIPS. Increasing the blood supply to the liver from the portal vein may improve the reduction of liver volume.

Transjugular Intrahepatic Portosystemic Shunt Is Associated With Better Waitlist Management of Liver Transplant Candidates With Hepatocellular Carcinoma

“…Consistent with our results, a meta-analysis of 859 patients by Chen et al [ 6 ] reported that TIPS placement did not increase the risk of HCC development among patients with cirrhosis. This might be due to the reduced proliferative activity of hepatocytes observed after TIPS placement, as reported by Delhaye et al [ 29 ] In contrast, two different studies investigated the impact of TIPS on hepatic blood flow [ 30 , 31 ] noted increased hepatic blood flow, particularly during the arterial phase of imaging. This observation raises concerns about potential HCC growth subsequent to arterialization of the liver.…”

A cohort study of transjugular intrahepatic portal systemic shunt in portal hypertension in cirrhosis

“…Although infusion and albumin treatment is the rst-line treatment for ascites, even if it is effective once, ascites Will still be repeated. Although the use of TIPS for ascites remains controversial and challenging, TIPS does improve patient survival and can control the repeated occurrence of ascites [5][6][7][8] However, ascites recurrence after TIPS is not only associated with postoperative PPG, but also with disease severity (as measured by the Child-Pugh score) and low sodium levels. For patients with cirrhotic ascites, TIPS can better control ascites and improve the 1-year survival of patients with refractory ascites, while the risk of hepatic encephalopathy was not signi cantly increased [9] .…”