Clinical outcomes after TIPS: comparison of patients with a history of partial splenic embolization vs splenectomy in cirrhosis.

Abstract

To compare clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients with a history of partial splenic embolization (PSE) vs splenectomy, focusing on shunt patency, overt hepatic encephalopathy (OHE), rebleeding, and survival. This retrospective study included 240 cirrhotic patients undergoing TIPS (TIPS + PSE: n = 126; TIPS + splenectomy: n = 114). After propensity score matching, 88 patients per group were analyzed. The primary endpoint was shunt dysfunction; secondary endpoints included OHE, rebleeding, and survival. TIPS + PSE group had lower rates of shunt dysfunction (10.2% vs 30.7%, p < 0.001) and OHE (17.1% vs 39.8%, p < 0.001) than TIPS+splenectomy. No differences were found in rebleeding or survival (p > 0.05). Cox regression showed the treatment group (PSE vs splenectomy) as an independent predictor of shunt dysfunction (HR = 3.24, 95% CI: 1.56-6.91, p = 0.002) and OHE (HR = 1.96, 95% CI: 1.03-3.74, p = 0.042). Portal vein thrombosis was identified as an independent predictor of shunt dysfunction (HR = 2.47, 95% CI: 1.16-5.27, p = 0.019). Age (HR = 1.04, 95% CI: 1.00-1.08, p = 0.046) and Model for end-stage liver disease score (HR = 1.20, 95% CI: 1.02-1.41, p = 0.027) were independent predictors of mortality. Among patients undergoing TIPS, those with prior PSE had a more favorable outcome regarding shunt dysfunction and OHE than those with prior splenectomy, with comparable rebleeding and survival. These findings support prioritizing PSE over splenectomy for patients who may later require TIPS. Question The influence of prior splenic intervention on outcomes after TIPS in cirrhotic patients with portal hypertension remains uncertain, particularly regarding the comparative effects of PSE vs splenectomy. Finding Among patients undergoing TIPS, those with prior PSE had a more favorable outcome regarding shunt dysfunction and OHE than those with prior splenectomy, with comparable rebleeding and survival. Clinical relevance TIPS after PSE offers better outcomes in reducing shunt dysfunction and overt OHE in cirrhotic patients with portal hypertension, supporting prioritizing PSE over splenectomy for patients who may later require TIPS.