Choudhary Moaz M, Nazeri Aria, Aldine Amro S, Mehta Ankit R, Kumar Girish, Kathuria Manoj K, Tujios Shannan R, Mufti Arjmand R, Kalva Sanjeeva P
Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Tech Vasc Interv Radiol. 2025 Sep;28(3):101062. doi: 10.1016/j.tvir.2025.101062. Epub 2025 Jul 14.
Transjugular intrahepatic portosystemic shunt (TIPS) is a key therapeutic intervention in the management of portal hypertension and its complications, such as variceal bleeding, hepatic hydrothorax, and refractory ascites. TIPS has historically been used as a lifesaving measure or as a bridge to liver transplantation (LT). Despite its efficacy, creation of a TIPS can be associated with significant morbidity, particularly in patients with decompensated cirrhosis. Complications include hepatic encephalopathy (HE), progressive liver dysfunction, and cardiovascular compromise. As such, accurate patient selection and risk stratification are essential to optimize clinical outcomes. This review synthesizes current evidence on predictive models for post-TIPS mortality. Traditional scoring systems such as the Child-Turcotte-Pugh (CTP) score and the Model for End-Stage Liver Disease (MELD) remain widely used, with newer iterations such as the MELD-Na and MELD 3.0 demonstrating improved prognostic accuracy. Notably, MELD 3.0 offers enhanced prediction of long-term mortality. In contrast, the Freiburg Index of Post-TIPS Survival (FIPS) has become a valuable tool for short-term mortality prediction. Additional models, including the Bilirubin-Platelet (Bili-PLT) score, offer further refinement. At the same time, the role of sarcopenia has gained attention as an independent and synergistic predictor of poor outcomes, especially when combined with MELD-based scores. Beyond mortality, this review explores the multifactorial pathophysiology of post-TIPS complications such as hepatic encephalopathy, liver failure, and right heart dysfunction that can cause significant morbidity. These outcomes are influenced by a spectrum of patient-related and procedural factors. Novel predictive approaches-encompassing clinical, radiological, and machine learning-based models-are being developed to better anticipate these risks.
经颈静脉肝内门体分流术（TIPS）是治疗门静脉高压及其并发症（如静脉曲张出血、肝性胸水和顽固性腹水）的关键治疗手段。从历史上看，TIPS一直被用作挽救生命的措施或肝移植（LT）的桥梁。尽管其疗效显著，但TIPS的创建可能会带来严重的并发症，尤其是在失代偿期肝硬化患者中。并发症包括肝性脑病（HE）、进行性肝功能障碍和心血管功能损害。因此，准确的患者选择和风险分层对于优化临床结果至关重要。本综述综合了当前关于TIPS术后死亡率预测模型的证据。传统的评分系统，如Child-Turcotte-Pugh（CTP）评分和终末期肝病模型（MELD）仍被广泛使用，MELD-Na和MELD 3.0等更新版本显示出更高的预后准确性。值得注意的是，MELD 3.0对长期死亡率的预测能力更强。相比之下，弗赖堡TIPS生存指数（FIPS）已成为短期死亡率预测的重要工具。其他模型，包括胆红素-血小板（Bili-PLT）评分，提供了进一步的细化。同时，肌肉减少症作为不良预后的独立和协同预测因素受到了关注，尤其是与基于MELD的评分相结合时。除了死亡率，本综述还探讨了TIPS术后并发症（如肝性脑病、肝功能衰竭和右心功能障碍）的多因素病理生理学，这些并发症可导致严重的发病率。这些结果受一系列患者相关因素和手术因素的影响。正在开发包括临床、放射学和基于机器学习的模型在内的新型预测方法，以更好地预测这些风险。
