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. 2025 Jan 3.
doi: 10.1097/HEP.0000000000001224. Online ahead of print.

End-procedural adherence to recommended hemodynamic targets does not improve the outcome of elective TIPS in patients with cirrhosis

Davide Roccarina  1   2 , Dario Saltini  3 , Valentina Adotti  1 , Martina Rosi  1 , Marco Senzolo  4 , Silvia Nardelli  5 , Marcello Bianchini  3 , Lara Biribin  4 , Cristian Caporali  6 , Falcini Margherita  1 , Lucia Ragozzino  1 , Tomas Guasconi  3 , Federico Casari  6 , Stefania Gioia  5 , Claudia Campani  1 , Francesco Prampolini  6 , Angelica Ingravallo  1 , Stefano Gitto  1 , Silvia Aspite  1 , Umberto Arena  1 , Michele Citone  7 , Melania Gaggini  8 , Lorenzo Ridola  9 , Giulio Barbiero  9 , Salvatore De Masi  10 , Oliviero Riggio  5 , Manuela Merli  5 , Fabrizio Fanelli  7 , Sara Montagnese  11   12 , Fabio Marra  1   13 , Filippo Schepis  3 , Francesco Vizzutti  1   14
Affiliations

End-procedural adherence to recommended hemodynamic targets does not improve the outcome of elective TIPS in patients with cirrhosis

Davide Roccarina et al. Hepatology. .

Abstract

Background and aims: In clinical practice, the reduction of portocaval pressure gradient (PCPG) following TIPS does not always meet the recommendation of current guidance. We evaluated the impact of different degrees of PCPG reduction, measured at the end of an elective TIPS, on ascites control, recurrence of portal hypertension-related bleeding (PHRB), and survival.

Approach and results: Patients with cirrhosis receiving TIPS for refractory ascites (RA) or for the secondary prophylaxis of PHRB were consecutively enrolled. Reduction in PCPG was defined as inadequate hemodynamic response (IHR) in patients not achieving a PCPG <12 mm Hg for both secondary prophylaxis of PHRB and RA, or a reduction of at least 50% only for PHRB. Four hundred fifteen patients were analyzed. An adequate hemodynamic response (AHR) was achieved in 66%. Fifty percent of patients received an under-dilated (≤7 mm) endoprosthesis. No significant differences between patients with IHR and AHR were observed in rebleeding rate and ascites control, while overt HE was higher in AHR. Regardless of TIPS indication, survival was not significantly different between IHR and AHR, while advanced age and liver function before TIPS were significantly associated with a higher cumulative incidence of liver-related death. Notably, in patients with RA the cumulative incidence of liver-related mortality was higher when AHR was defined as a post-TIPS PCPG <12 mm Hg or a reduction ≥50%.

Conclusions: AHR measured at the end of an elective TIPS may not be essential to define the eventual outcome, while a marked drop in PCPG could negatively affect the prognosis of patients with RA.

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