Relationship between pre-TIPS liver perfusion by the portal vein and the incidence of post-TIPS chronic hepatic encephalopathy

OBJECTIVE: In the present study we evaluated the predictive value of pretra nsjugular intrahepatic portosystemic shunt (TIPS) portal perfusion as asses sed by Doppler ultrasonography for the onset of chronic encephalopathy afte r TIPS. METHODS: A total of 231 cirrhotic patients were followed-up prospectively a fter TIPS placement. The pattern of intrahepatic portal flow was assessed b efore TIPS. Patients were divided into two groups according to Doppler find ings. Group 1 comprised patients with prograde portal flow (n = 200), where as group 2 comprised those with loss of portal perfusion (hepatofugal or ba ck-and-forth flow or portal vein thrombosis; n = 31). The presence of chron ic encephalopathy during a median follow-up of 32 months was prospectively recorded. The prognostic value of the following parameters for the onset of chronic recurrent encephalopathy after TIPS was evaluated: age, presence o f encephalopathy before TIPS, alcoholism, Pugh score, and loss of portal pe rfusion before TIPS. The independent prognostic value of each variable was tested with a multiple logistic regression analysis. RESULTS: The two groups were comparable in terms of age, incidence of prior episodes of hepatic encephalopathy. and portacaval gradient before and aft er the procedure; however, liver failure was more severe in patients in gro up 2 (Pugh score: 9.2 +/- 1.9 vs 10.3 +/- 1.7). The 3-yr survival was ident ical for both groups; 25% of the 200 patients in group 1 developed chronic encephalopathy as compared to 6% of the 31 patients in group 2 (p = 0.03). Multiple logistic regression analysis demonstrated that loss of portal perf usion and age >65 yr were the only independent predictors of the onset of p ost-TIPS chronic encephalopathy (odds ratios 0.24 and 1.98, respectively). CONCLUSIONS: Cirrhotic patients with loss of portal perfusion before TIPS w ere protected against post-TIPS chronic hepatic encephalopathy despite a mo re severe liver dysfunction at baseline. The only other independent predict ive factor for the onset of this complication was age. (Am J Gastroenterol 2001;96:1205-1209. (C) 2001 by Am. Coll. of Gastroenterology).