Abstract No. 275 Long-Term Impact of Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation on Hepatic Morphology

The impact of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic function remains controversial. As portal blood has been shown to contain factors that are trophic to the liver, reduction in portal flow into the liver parenchyma has the potential to impact hepatic function. While it is often held that this decrease in intrahepatic hepatopetal flow may result in deterioration of hepatic function, evidence is lacking. The purpose of this study was to evaluate long-term morphologic changes occurring in the liver after TIPS creation with correlation with hepatic function to gain insight on the physiologic impact of TIPS on the liver. This retrospective study included patients who underwent TIPS placement between 2005 and 2022 and had contrasted CT or MRI studies prior to and between 1-2 years post procedure. Patients with portal vein thrombus, pre-existing major lobar atrophy, or uncorrectable TIPS dysfunction were excluded. Parenchymal volume and vessel measurements were assessed on the pre- and post-TIPS CT or MRI with MELD scores calculated at these timepoints. Of 580 patients undergoing TIPS placement, 65 patients (mean age, 55 years; 36 males) had assessable pre-TIPS and post-TIPS imaging at median 16.5 months. The mean MELD score increased from 12.9 to 15.4 (p=0.008) over this interval. Mean total liver volume decreased from 1730 to 1432 mL (p< 0.001) but did not correlate with changes in MELD scores. Neither portosystemic gradient nor TIPS laterality correlated with total or lobar hepatic volume changes or MELD changes. The main portal vein diameter increased after TIPS, from 14.8 to 18.2 mm (p< 0.001). Thrombosis of the hepatic vein used for TIPS creation resulted in a mean increase in MELD of +4.1 compared to -2.1 in patients who had a patent and normal hepatic vein (p=0.007). Given lack of correlation between portosystemic gradient, hepatic atrophy, hepatic function, and TIPS laterality, the alterations in portal flow dynamics after TIPS may not be impactful to hepatic function. However, main portal vein hypertrophy was frequently observed after TIPS, which may be beneficial for liver transplantation. Hepatic vein thrombosis after TIPS was common and correlated with worsening hepatic function, suggesting that strategies to maintain hepatic venous patency may improve outcomes for patients after TIPS placement and warrant further study.