Hepatic encephalopathy and survival after transjugular intrahepatic portosystemic shunt: Do spontaneous portosystemic shunts matter?

We read the recently published article, "Episodic overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt does not increase mortality in patients with cirrhosis," with great interest. In this article [1] Nardelli S. Riggio O. Marra F. et al. Episodic overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt does not increase mortality in patients with cirrhosis. J Hepatol. 2023; (Epub ahead of print) Google Scholar , Nardelli S. and colleagues conducted a multicenter, non-inferiority observational study to evaluate the mortality rate in patients with and without overt hepatic encephalopathy (OHE) after elective transjugular intrahepatic portosystemic shunt (TIPS) for variceal rebleeding prophylaxis or refractory ascites. During a median follow-up of 30 months, 293 (47%) patients developed at least one episode of OHE. Age (sHR 1.04, 95% CI 1.02–1.05, p<0.001) and MELD (sHR 1.09, 95% CI 1.05–1.13, p<0.001), but not post-TIPS OHE, were associated with a higher mortality rate. These results highlight that post-TIPS episodic OHE does not increase the risk of death in patients undergoing TIPS, although it has been well established that OHE is associated with mortality in common cirrhotic patients not undergoing TIPS. It was notable that the embolization of spontaneous portosystemic shunts (SPSS) was not performed in the cohort. The authors did not present the prevalence and diameter of SPSS and did not explore the relationship between SPSS and OHE, especially survival. Episodic overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt does not increase mortality in patients with cirrhosisJournal of HepatologyPreviewIn patients with cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) is indicated for the prophylaxis of variceal re-bleeding and treatment of refractory ascites. Overt hepatic encephalopathy (OHE) is a major complication after TIPS, given its high incidence and possibility of refractoriness to medical treatment. Nevertheless, the impact of post-TIPS OHE on mortality has not been investigated in a large population. Full-Text PDF Open Access Author names in bold designate shared co-first authorship