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Introduction <p>The use of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) effectively controls portal hypertension (PH)-related complications while reducing risks related to fully expanded stents. We evaluated the effectiveness of CX-TIPS in a&#xa0;large Viennese patient cohort.</p> Method <p>We assessed the number of patients evaluated for CX-TIPS placement by interdisciplinary discussion at the Medical University of Vienna and included all patients from the prospective AUTIPS registry undergoing CX-TIPS placement between June 2018 – December 2024. After clinical and laboratory characterization at baseline, patients were followed up for clinical events.</p> Results <p>Overall, 200 patients underwent interdisciplinary evaluation for CX-TIPS. In 62.5% CX-TIPS was recommended and 82.4% of these patients underwent CX-TIPS placement. Among 103 patients with CX-TIPS placement between June 2018 – December 2024 (median age&#xa0;57&#xa0;years, 67.0% male, median MELD&#xa0;11), the primary indication for CX-TIPS implantation was ascites (65.0%). The median portal pressure gradient decreased from 18 mm Hg to 8 mm Hg after CX-TIPS. Underdilated CX-TIPS placement was performed in 13.6% (<i>n</i> = 14) of patients and portal vein recanalization (PVR-TIPS) was performed in 4&#xa0;patients. During a&#xa0;median follow-up time of 13.5 months, 30.1% of patients experienced hepatic encephalopathy and 5.8% cardiac decompensation. Kaplan-Meier survival analyses revealed 1‑year and 3‑year transplant-free survival rates of 78.0% and 74.7%, respectively.</p> Conclusion <p>Implementation of interdisciplinary case discussions and the use of CX-TIPS enable personalized medicine in patients with cirrhosis. Underdilation of CX-TIPS should be considered in patients at high risk for complications.</p>

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Effectiveness of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) in an interdisciplinary setting at a large tertiary center

  • 期刊论文

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  • 发表日期：

    2025年9月4日

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  • Marlene Hintersteininger,
  • Julia Kappel,
  • Theresa Müllner-Buscics,
  • Susanna Riegler,
  • Nina Dominik,
  • Georg Kramer,
  • Christian Sebesta,
  • Paul Thöne,
  • Albert Friedrich Stättermayer,
  • Lukas Reider,
  • Maria Schoder,
  • Catharina Klausenitz,
  • Raoul Varga,
  • Fredrik Waneck,
  • Michael Trauner,
  • Mattias Mandorfer,
  • Thomas Reiberger,
  • Lukas Hartl

摘要

Introduction

The use of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) effectively controls portal hypertension (PH)-related complications while reducing risks related to fully expanded stents. We evaluated the effectiveness of CX-TIPS in a large Viennese patient cohort.

Method

We assessed the number of patients evaluated for CX-TIPS placement by interdisciplinary discussion at the Medical University of Vienna and included all patients from the prospective AUTIPS registry undergoing CX-TIPS placement between June 2018 – December 2024. After clinical and laboratory characterization at baseline, patients were followed up for clinical events.

Results

Overall, 200 patients underwent interdisciplinary evaluation for CX-TIPS. In 62.5% CX-TIPS was recommended and 82.4% of these patients underwent CX-TIPS placement. Among 103 patients with CX-TIPS placement between June 2018 – December 2024 (median age 57 years, 67.0% male, median MELD 11), the primary indication for CX-TIPS implantation was ascites (65.0%). The median portal pressure gradient decreased from 18 mm Hg to 8 mm Hg after CX-TIPS. Underdilated CX-TIPS placement was performed in 13.6% (n = 14) of patients and portal vein recanalization (PVR-TIPS) was performed in 4 patients. During a median follow-up time of 13.5 months, 30.1% of patients experienced hepatic encephalopathy and 5.8% cardiac decompensation. Kaplan-Meier survival analyses revealed 1‑year and 3‑year transplant-free survival rates of 78.0% and 74.7%, respectively.

Conclusion

Implementation of interdisciplinary case discussions and the use of CX-TIPS enable personalized medicine in patients with cirrhosis. Underdilation of CX-TIPS should be considered in patients at high risk for complications.