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, n = 479); group B (variceal hemorrhage and PSG reduced to < 12 mmHg, n = 412); group C (refractory ascites and PSG reduced by one third, n = 217); and group D (refractory ascites and PSG reduced to < 12 mmHg of PSG, plus medication, n = 172). The clinical outcomes were analyzed. RESULTS: By the endpoint of follow-up, recurrent bleeding was no different between groups A and B (χ(2) = 7.062, P = 0.374), but recurrent ascites did differ significantly between groups C and D (χ(2) = 14.493, P = 0.006). The probability of total hepatic impairment within 3 years was significantly different between groups A and B (χ(2) = 11.352, P = 0.005) and groups C and D (χ(2) = 13.758, P = 0.002). The total incidence of HE differed significantly between groups A and B (χ(2) = 7.932, P = 0.016), groups C and D (χ(2) = 13.637, P = 0.007). There were no differences of survival rate between groups A and B (χ(2) = 3.376, P = 0.369, log-rank test), but did differ significantly between groups C and D (χ(2) = 13.582, P = 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.