The Impact of Transjugular Intrahepatic Portosystemic Shunt on Recompensation in Patients With Decompensated Liver Cirrhosis

Summary

The traditional view holds that the natural course of cirrhosis is a unidirectional process, characterized by irreversible progression from the compensated stage to the decompensated stage, and is highly likely to develop further decompensation events or even death. However, a growing body of evidence suggests that the natural course of cirrhosis is not always unidirectional - after the removal of the etiology, the structural and functional changes of the liver may be partially reversed. This understanding has given rise to the concept of "liver recompensation," which has been standardized at the Baveno VII Consensus Conference. Notably, in a cohort of patients with alcohol-related cirrhosis, 18% achieved recompensation, which was significantly associated with a reduction of more than 90% in liver-related mortality. In patients with hepatitis B-related cirrhosis, 6% achieved recompensation after treatment with nucleos(t)ide analogs, with a similar improvement in mortality.

Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established therapy for complications related to portal hypertension, including gastroesophageal variceal bleeding, refractory ascites, and hepatic hydrothorax. Compared with standard treatment, TIPS has been proven to reduce the incidence of further decompensation and improve transplant-free survival. However, due to portal blood shunting, the risks of abnormal liver function and hepatic encephalopathy (HE) also increase. It is worth noting that TIPS is not included in the definition of recompensation in the Baveno VII Consensus. Therefore, whether patients with cirrhosis who undergo TIPS treatment can achieve recompensation and which factors determine the probability of recompensation remain unknown. More importantly, the impact of recompensation on the risk of HCC development and mortality in TIPS patients has not been studied prospectively.

Conditions

• Cirrhosis
• Decompensation
• Transjugular Intrahepatic Portosystemic Shunt (TIPS)
• Survival Analysis

Sponsors & Collaborators

• Zhongnan Hospital

  collaborator OTHER

• Yichang Central People's Hospital

  collaborator OTHER

• Jingzhou Central Hospital

  collaborator OTHER

• Xiangyang Central Hospital

  collaborator OTHER

• Jiangxi Provincial People's Hopital

  collaborator OTHER

• The Central Hospital of Huanggang

  collaborator OTHER

• Second Xiangya Hospital of Central South University

  collaborator OTHER

• Shengjing Hospital

  collaborator OTHER

• The First Affiliated Hospital with Nanjing Medical University

  collaborator OTHER

• Shanxi Provincial People's Hospital

  collaborator OTHER_GOV

• The First Affiliated Hospital of Zhengzhou University

  collaborator OTHER

• The Third Xiangya Hospital of Central South University

  collaborator OTHER

• Fujian Medical University Union Hospital

  collaborator OTHER

• Renmin Hospital of Wuhan University

  collaborator OTHER

• Union Hospital, Tongji Medical College, Huazhong University of Science and Technology

  lead OTHER

Eligibility

Min Age

18 Years

Max Age

80 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-08-01

Primary Completion

2027-08-01

Completion

2027-08-01

Countries

• China

Study Locations