Determining the optimal portal pressure gradient after small-diameter TIPS for ascites: a retrospective study.

BACKGROUND

The optimal hemodynamic threshold for portal pressure gradient (PPG) following transjugular intrahepatic portosystemic shunt (TIPS) for ascites remains uncertain.

OBJECTIVE

This study aimed to elucidate the relationship between post-TIPS PPG and clinical outcomes in patients undergoing small-diameter (8-mm) TIPS for ascites.

DESIGN

Single-center retrospective study.

METHODS

From June 2015 to June 2023, consecutive patients receiving small-diameter (8-mm) TIPS for refractory or recurrent ascites were considered for inclusion retrospectively. The impact of PPG on clinical outcomes-including ascites response, overt hepatic encephalopathy (OHE), further decompensation, and mortality-was evaluated using Fine and Gray competing risk regression models, both unadjusted and adjusted for potential confounders.

RESULTS

A total of 143 patients were included in the analysis, of whom 65.7% had refractory ascites, with a median Child-Pugh score of 9. Receiver operating characteristic (ROC) curve analysis identified post-TIPS PPG as a reliable predictor of ascites response (cutoff: 10.5 mmHg, area under curves (AUC): 0.733, p < 0.001) and OHE (cutoff: 7.5 mmHg, AUC: 0.716, p < 0.001). Univariate and multivariate Fine and Gray competing risk regression analyses further revealed that patients with PPG between 8 and 10 mmHg had favorable outcomes, including a lower incidence of ascites (>10 vs 8-10 mmHg: hazard ratio (HR) = 5.74, 95% confidence interval (CI) 2.11-15.58, p < 0.001), a reduced risk of OHE (<8 vs 8-10 mmHg: HR = 2.87, 95% CI 1.29-6.35, p = 0.010), and a decreased risk of further decompensation (>10 vs 8-10 mmHg: HR = 2.78, 95% CI 1.43-5.41, p = 0.003; <8 vs 8-10 mmHg: HR = 2.42, 95% CI 1.20-4.90, p = 0.014) after TIPS placement.

CONCLUSION

This study revealed that post-TIPS PPG was associated with clinical outcomes in patients with refractory or recurrent ascites undergoing small-diameter TIPS. A post-TIPS PPG of 8-10 mmHg seems to be the optimal range, effectively controlling ascites without significantly increasing the risk of shunt-related hepatic encephalopathy, while also reducing the risk of further decompensation.