HEPATIC-ENCEPHALOPATHY AFTER TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT - INCIDENCE AND RISK-FACTORS

Forty-seven consecutive patients were prospectively evaluated to study the incidence of hepatic encephalopathy as well as modifications in t he PSE index after TIPS, Various clinical, laboratory, and angiographi c parameters were also recorded to identify risk factors for the devel opment of post-TIPS hepatic encephalopathy (HE), Mean follow-up was 17 +/- 7 months. During follow-up, six patients died and one underwent t ransplantation, All other patients were followed for at least a year, Fifteen patients (32%) experienced 20 acute episodes of precipitated H E (hospitalization was necessary in 10 instances), and five patients ( 11%) presented a continuous alteration in mental status with frequent spontaneous exacerbation during follow-up, Both precipitated and spont aneous HE occurred more frequently during the first three months of fo llow-up, Moreover the PSE index was significantly worse than basal val ues one month after TIPS, thereafter returning to near basal values, H E was successfully treated in all patients but one who required a redu ction in the stent/shunt diameter. Increasing age (>65 years) and low portacaval gradient (<10 mm Hg) were predictors of HE after TIPS. A gr adual dilation of the stent/shunt should be performed to obtain a port acaval gradient >10 mm Hg to avoid an unacceptable rate of HE after TI PS.