Clinical and Molecular Hepatology

"Transjugular intrahepatic portosystemic shunt"

Review

Update in the treatment of cirrhotic patients with portal vein thrombosis: Jialin Wu, Xinyi Deng, Junyang Luo, Zaibo Jiang, Fuda Xie, Bonan Chen, Hoi Wing Leung, Ge Zhang, Ka Fai To, Wei Kang; Clin Mol Hepatol 2025;31(4):1139-1166.
Published online June 24, 2025; DOI: https://doi.org/10.3350/cmh.2025.0411

Abstract
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Portal vein thrombosis (PVT) is characterized by the formation of a thrombus (blood clot) within the portal vein system, including main portal vein and its intrahepatic portal vein branches, and may extend to the superior mesenteric vein or splenic vein. The emergence of PVT is linked to diverse risk factors, encompassing liver conditions with cirrhosis, abdominal infections, previous abdominal surgeries, malignancies, inherited or acquired thrombophilias, and systemic hypercoagulable conditions. Recent studies revealed a possible connection between the occurrence of PVT and either contracting corona virus disease 2019 (COVID-19) or receiving a COVID-19 vaccination. Current treatment strategies were primarily based on symptom management, extent, and progression of thrombosis, but their efficacy was inconsistent and suboptimal. Untimely or inadequate treatment can lead to the progression of the thrombus and increase the risk of complications, such as portal hypertension, variceal bleeding, and hepatic decompensation, posing a significant risk to the patient’s life. Thus, early and appropriate initiation of pharmacologic and interventional treatments, as well as more aggressive strategies, is crucial for the management and prevention of PVT progression and recurrence. This review focuses on the literature on the recent advancements in the treatment of PVT using various therapeutic modalities, including anticoagulant therapy, thrombolysis, thrombectomy, interventional therapy and liver transplant in cirrhotic patients. In addition, we discuss pearls and pitfalls of these strategies for PVT, highlighting recent progress, identifying knowledge gaps, and proposing avenues towards precision management.

Citations

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Gastrointestinal bleeding risk in cirrhotic portal vein thrombosis: focus on thrombus extension to superior mesenteric vein
Sa Lv, Hui Feng, Tianjiao Xu, Hua Tian, Haibo Wang, Dongze Li, Shaoli You, Bing Zhu
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Letter: Beyond Survival Benefit in CHANCE2311—Important Considerations in the Interpretation of TACE Combined With Immunotherapy in Advanced HCC
Yinghan Chen, Caiyun Lu, Yucheng Xu, Zhidong Zang
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Risk factors and predictive model for transjugular intrahepatic portosystemic shunt dysfunction in cirrhotic patients
Yongbing Zhao, Tingwei Xiong, Sijie Hu, Hao Zhou, En Liu, Zhengguo Xu, Rui Xie
European Journal of Gastroenterology & Hepatology.2026;[Epub] CrossRef
Acute portal vein thrombosis in an elderly man with homozygous mutations of plasminogen activator inhibitor-1 and methylenetetrahydrofolate reductase genes
Junxiu Chen, Haonan Zhao, Shengye Yang, Huiyuan Lu, Xingshun Qi
Archives of Medical Science.2025;[Epub] CrossRef
Prediction of bowel resection due to bowel necrosis in recent portal vein thrombosis based on CT presentations and clinical data
Junyang Luo, Junwei Chen, Hua Tang, Jialin Wu, Xiaohong Wang, Zaibo Jiang, Jie Qin
BMC Gastroenterology.2025;[Epub] CrossRef
Long-term patency of the transjugular intrahepatic portosystemic shunt for portal and superior mesenteric vein thrombosis
Junyang Luo, Churen Zhou, Yanyang Zhang, Haofan Wang, Caiyun Lu, Jialin Wu, Jie Qin, Zaibo Jiang, Junwei Chen
Thrombosis Journal.2025;[Epub] CrossRef

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Reply to Correspondence

Liver fibrosis, cirrhosis, and portal hypertension

Decreasing systemic inflammation after TIPS: Still hope for the liver: Reply to correspondence on “Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis”: Georg Semmler, Lorenz Balcar, Mattias Mandorfer; Clin Mol Hepatol 2025;31(2):e224-e225.
Published online February 17, 2025; DOI: https://doi.org/10.3350/cmh.2025.0149

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Systemic inflammatory indexes as predictors of 18-month mortality among cirrhotic patients receiving transjugular intrahepatic portosystemic shunt
Jie Cheng, Xiaobing Wang, Lihua Zhou, Xiaojia Chen, Nuer Tang, Feng Zhou, Feng Ding, Yuan Yang, Jun Lin, Liping Chen
Annals of Medicine.2025;[Epub] CrossRef

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Correspondence

Liver fibrosis, cirrhosis, and portal hypertension

TIPS insertion and systemic inflammation: Is it ever too late to lower portal pressure? Correspondence to editorial on “Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis”: Anja Tiede, Benjamin Maasoumy; Clin Mol Hepatol 2025;31(2):e176-e179.
Published online February 10, 2025; DOI: https://doi.org/10.3350/cmh.2025.0135

Citations

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Outcomes after TIPS in patients with cirrhosis and sarcopenia: A systematic review and meta-analysis
Maria de Brito Nunes, Maria Gabriela Delgado, Jaume Bosch, Annalisa Berzigotti
JHEP Reports.2026; 8(2): 101699. CrossRef
CIRROSE HEPÁTICA EM HOMENS ADULTOS: UMA REVISÃO INTEGRATIVA
Matheus Cavalcanti Saraiva, Thales Gabriel de Azevedo Costa, Maria Auxiliadora Menezes De Souza, Luisa Margareth Carneiro Da Silva, Ana Lúcia Rocha Faillace, Ana Lúcia da Silva Resende
ARACÊ .2026; 8(3): e12482. CrossRef
Decreasing systemic inflammation after TIPS: Still hope for the liver: Reply to correspondence on “Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrh
Georg Semmler, Lorenz Balcar, Mattias Mandorfer
Clinical and Molecular Hepatology.2025; 31(2): e224. CrossRef
Advancing our understanding of recompensated cirrhosis - the new “holy grail” of decompensated cirrhosis
Thomas Reiberger, Benjamin Maasoumy
Journal of Hepatology.2025; 83(3): 615. CrossRef

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Original Article

Liver fibrosis, cirrhosis, and portal hypertension

Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis: Anja Tiede, Lena Stockhoff, Zhaoli Liu, Hannah Rieland, Jim B. Mauz, Valerie Ohlendorf, Birgit Bremer, Jennifer Witt, Anke Kraft, Markus Cornberg, Jan B. Hinrichs, Bernhard C. Meyer, Heiner Wedemeyer, Cheng-Jian Xu, Christine S. Falk, Benjamin Maasoumy; Clin Mol Hepatol 2025;31(1):240-255.
Published online November 21, 2024; DOI: https://doi.org/10.3350/cmh.2024.0587

Background/Aims
Systemic Inflammation (SI) is considered a key mechanism in disease progression and development of complications in decompensated liver cirrhosis. SI is mainly driven by portal hypertension and bacterial translocation. Transjugular intrahepatic portosystemic shunt (TIPS) insertion represents an effective treatment for portal hypertension. This study aims to investigate the impact of TIPS insertion on SI and bacterial translocation.
Methods
We prospectively included 59 cirrhotic patients undergoing TIPS insertion. Blood samples were collected at TIPS insertion and follow-up (FU) 1, 3, 6, and 12 months thereafter. At all time points, we performed a comprehensive analysis of SI including 43 soluble inflammatory markers (SIMs), and surrogates of bacterial translocation (sCD14, sCD163). To investigate long-term kinetics of SI, C-reactive protein (CRP) and white blood cells (WBC) were retrospectively analyzed in a cohort of 177 patients up to 3 years after TIPS insertion.
Results
At TIPS insertion, 30/43 SIMs, sCD14, and sCD163 measured significantly higher in cirrhotic patients compared to healthy controls. By FU6 25 SIMs and sCD14 measured at significantly lower levels compared to baseline. Interestingly, in patients with TIPS indication of refractory ascites, IL-6 decreased to levels documented in earlier stages of cirrhosis. In long-term follow-up, CRP levels significantly decreased after TIPS insertion, which translated into lower mortality in Cox regression analysis (HR 0.968, p=0.042). Notably, patients with residual ascites post-TIPS showed significantly higher CRP and IL-6 levels across all follow-ups compared to patients with resolved ascites.
Conclusions
Decreasing portal hypertension via TIPS insertion leads to a significant attenuation of SI and bacterial translocation over time.

Citations

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Reply
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Systemic inflammatory indexes as predictors of 18-month mortality among cirrhotic patients receiving transjugular intrahepatic portosystemic shunt
Jie Cheng, Xiaobing Wang, Lihua Zhou, Xiaojia Chen, Nuer Tang, Feng Zhou, Feng Ding, Yuan Yang, Jun Lin, Liping Chen
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Thomas Reiberger, Benjamin Maasoumy
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Review

Liver fibrosis, cirrhosis, and portal hypertension

The role of transjugular intrahepatic portosystemic shunt in patients with portal hypertension: Advantages and pitfalls: Hae Lim Lee, Sung Won Lee; Clin Mol Hepatol 2022;28(2):121-134.
Published online September 27, 2021; DOI: https://doi.org/10.3350/cmh.2021.0239

Abstract
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Transjugular intrahepatic portosystemic shunt (TIPS) is an effective interventional procedure to relieve portal hypertension, which is a main mechanism for the development of complications of liver cirrhosis (LC), such as variceal hemorrhage, ascites, and hepatorenal syndrome. However, the high incidence of adverse events after TIPS implementation limits its application in clinical practice. Esophageal variceal hemorrhage is one of the major indications for TIPS. Recently, preemptively performed TIPS has been recommended, as several studies have shown that TIPS significantly reduced mortality as well as rebleeding or failure to control bleeding in patients who are at high risk of treatment failure for bleeding control with endoscopic variceal ligation and vasoactive drugs. Meanwhile, recurrent ascites is another indication for TIPS with a proven survival benefit. TIPS may also be considered as an effective treatment for other LC complications, usually as an alternative therapy. Although there are concerns about the development of hepatic encephalopathy and hepatic dysfunction after TIPS implementation, careful patient selection using prognostic scores can lead to excellent outcomes. Assessments of cardiac and renal function prior to TIPS may also be considered to improve patient prognosis.

Citations

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Original Article

Liver fibrosis, cirrhosis, and portal hypertension

Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data: Hyung Ki Kim, Yoon Jun Kim, Woo Jin Chung, Soon Sun Kim, Jae Jun Shim, Moon Seok Choi, Do Young Kim, Dae Won Jun, Soon Ho Um, Sung Jae Park, Hyun Young Woo, Young Kul Jung, Soon Koo Baik, Moon Young Kim, Soo Young Park, Jae Myeong Lee, Young Seok Kim; Clin Mol Hepatol 2014;20(1):18-27.
Published online March 26, 2014; DOI: https://doi.org/10.3350/cmh.2014.20.1.18

Abstract
PDF

Background/Aims

This retrospective study assessed the clinical outcome of a transjugular intrahepatic portosystemic shunt (TIPS) procedure for managing portal hypertension in Koreans with liver cirrhosis.

Methods

Between January 2003 and July 2013, 230 patients received a TIPS in 13 university-based hospitals.

Results

Of the 229 (99.6%) patients who successfully underwent TIPS placement, 142 received a TIPS for variceal bleeding, 84 for refractory ascites, and 3 for other indications. The follow-up period was 24.9±30.2 months (mean±SD), 74.7% of the stents were covered, and the primary patency rate at the 1-year follow-up was 78.7%. Hemorrhage occurred in 30 (21.1%) patients during follow-up; of these, 28 (93.3%) cases of rebleeding were associated with stent dysfunction. Fifty-four (23.6%) patients developed new hepatic encephalopathy, and most of these patients were successfully managed conservatively. The cumulative survival rates at 1, 6, 12, and 24 months were 87.5%, 75.0%, 66.8%, and 57.5%, respectively. A high Model for End-Stage Liver Disease (MELD) score was significantly associated with the risk of death within the first month after receiving a TIPS (P=0.018). Old age (P<0.001), indication for a TIPS (ascites vs. bleeding, P=0.005), low serum albumin (P<0.001), and high MELD score (P=0.006) were associated with overall mortality.

Conclusions

A high MELD score was found to be significantly associated with early and overall mortality rate in TIPS patients. Determining the appropriate indication is warranted to improve survival in these patients.

Citations

Citations to this article as recorded by

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