Reduction of portosystemic gradient during transjugular intrahepatic portosystemic shunt achieves good outcome and reduces complications.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is placed important role in the therapy of complications of portal hypertension, there is still no suitable criterion for a reduction in portosystemic gradient (PSG), which can both reduce PSG and maximize clinical results and minimize hepatic encephalopathy (HE).

Aim: To compare the clinical outcomes and incidence of HE after one-third PSG reduction during TIPS in patients with variceal bleeding and refractory ascites.

Methods: A total of 1280 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2016 to January 2019 were analyzed retrospectively. Patients were divided into group A (variceal hemorrhage and PSG reduced by one third, = 479); group B (variceal hemorrhage and PSG reduced to < 12 mmHg, = 412); group C (refractory ascites and PSG reduced by one third, = 217); and group D (refractory ascites and PSG reduced to < 12 mmHg of PSG, plus medication, = 172). The clinical outcomes were analyzed.

Results: By the endpoint of follow-up, recurrent bleeding was no different between groups A and B ( = 7.062, = 0.374), but recurrent ascites did differ significantly between groups C and D ( = 14.493, = 0.006). The probability of total hepatic impairment within 3 years was significantly different between groups A and B ( = 11.352, = 0.005) and groups C and D ( = 13.758, = 0.002). The total incidence of HE differed significantly between groups A and B ( = 7.932, = 0.016), groups C and D ( = 13.637, = 0.007). There were no differences of survival rate between groups A and B ( = 3.376, = 0.369, log-rank test), but did differ significantly between groups C and D ( = 13.582, = 0.014, log-rank test).

Conclusion: The PSG reduction by one third may reduce the risk of HE, hepatic function damage and achieve good clinical results.