Transjugular intrahepatic
portosystemic shunt (
TIPS) relieves hepatic venous obstruction in
Budd-Chiari syndrome (BCS), but the effect on liver function is unclear, particularly outside the immediate post-treatment period. This study aims to evaluate the long-term impact of
TIPS on liver function and outcomes in BCS patients.
Methods: Twenty patients with BCS who underwent
TIPS from 1999 to 2018 were included. Demographic data and clinical data at the time of
TIPS procedure, 6 months, 12 months, 2 years, 5 years, and 10 years post-
TIPS were collected.
Results: There were 13 (13/20, 65%) women and 7 (7/20, 35%) men with a mean age at the time of
TIPS of 42.6 ± 12.8 years. The median time from BCS diagnosis to
TIPS was 41 (IQR: 4-165) days. The number of patients with severe
ascites decreased significantly from 10/17 (58.8%) at the time of
TIPS, to 1/16 (7.7%), 1/13 (7.7%), 2/16 (12.5%), 1/14 (7.1%), and 0/8 (0%) at 6 months, 12 months, 2 years, 5 years and 10 years post-
TIPS, respectively. 4/20 (20%) patients developed new
hepatic encephalopathy post-
TIPS procedure. Child-Pugh score significantly decreased from a score of 9.4 ± 1.8 pre-
TIPS to 7.6 ± 1.8 at 6 months, 7.4 ± 1.5 at 12 months, 7.3 ± 1.6 at 2 years, 6.8 ± 1.5 at 5 years, and 6.4 ± 0.7 at 10 years post-
TIPS. Fifteen (15/20, 75%) patients required
TIPS revision including 4 (4/15, 26.7%) within 30 days, 2 (2/15, 13.3% within 1 month to 1 year, and 9 (9/15, 60%) at more than 1 year. Eight (8/20, 40%) patients underwent
liver transplantation (LT) at median time of 7.3 (IQR 3.2-12.9) years after
TIPS.
Conclusion:
TIPS placement for BCS results in sustained resolution of symptoms and improved liver function. Despite the frequent need for revisions, the long-term durability of
TIPS can forgo the need for LT in the majority of patients.