Segmental intrahepatic cholestasis as a technical complication of the transjugular intrahepatic porto-systemic shunt

Table 1 Patient demographics and clinical data of retrospectively screened cohort

Characteristic	Value
Age1	55 (19, 54, 84)
Female	28 (20.7)
Male	107 (79.3)
Etiology of cirrhosis
Alcoholic	114 (84.4)
NASH	7 (5.2)
BCS	4 (3.0)
Kryptogenic	3 (2.2)
HCV	2 (1.5)
PBC	1 (0.7)
Autoimmune	1 (0.7)
Hemochromatosis	1 (0.7)
HBV	1 (0.7)
Toxic	1 (0.7)
Indications for TIPS
RA	83 (61.5)
RVB	38 (28.4)
HRS	10 (7.5)
BCS	3 (2.2)
Others	1 (0.7)
Technique
MHV-RPV	107 (79.3)
RHV-RPV	15 (11.1)
LHV-LPV	2 (1.5)
MHV-LPV	1 (0.7)
Unknown	10 (7.4)
Time with TIPS2	7 (0, 19, 148)
Revision
No revision	105 (77.8)
1 revision	28 (20.7)
More than 1 revision	2 (1.5)
Indications for revision
Encephalopathy	8 (26.7)
Low shunt flow	8 (26.7)
Thrombosis	14 (46.7)
End of follow-up
Loss to follow-up	99 (73.3)
Death with TIPS	20 (14.8)
Consecutive LTx	17 (12.6)

¹At TIPS-placement in years; median; min; mean; max;

²At end of screening; in months; median; min; mean; max. NASH: Non alcoholic steatohepatitis; BCS: Budd Chiari Syndrome; HCV: Hepatitis C; PBC: Primary biliary cholangits; HBV: Hepatitis B; RA: Refractory ascites; HRS: Hepatorenal syndrome; MHV: Medial hepatic vein; RPV: Right portal branch; RHV: Right hepatic vein; RVB: Refractory variceal bleeding; LHV: Left hepatic vein; LPV: Left portal branch; LTx: Liver transplantation; TIPS: Transjugular intrahepatic portosystemic shunt.

Table 2 Characteristics of patients presenting with segmental intrahepatic cholestasis after intervention

Patient	Age1	Sex	Aetiolog-y of cirrhosis	Indicati-on for TIPS	TIPS-type	TIPS Localisa-tion	Congest-ed segment-s	SIC-T free intervall with TIPS2	Time from last imaging without SIC-T suspi-cion2	MELD before SIC-T diagno-sis	MELD at SIC-T diagno-sis	Relevant complica-tions
1	51	M	Alcoholic	RA & HRS	PTFE-covered	RHV-RPV	VII	72	39	11	12	None
2	55	M	Alcoholic	RA	PTFE-covered	RHV-RPV	VII	83	26	19	16	None
3	49	F	alcoholic	RA & HRS	PTFE-covered	MHV-RPV	V	17	< 1	18	22	SBP
4	44	M	BCS	RA	PTFE-covered	Atypical	I	0,4	< 1	10	9	Hepatic abscess

¹At TIPS-placement in years;

²In months. M: Male; F: Female; BCS: Budd Chiari Syndrome; RA: Therapy refractory ascites; HRS: Hepatorenal syndrome; PTFE: Polytetrafluorethylen; MHV: Medial hepatic vein; RHV : Right hepatic vein; RPV: Right portal branch; SIC-T: Segmental intrahepatic cholestasis caused by intrahepatic bile duct compression by the TIPS-stent; MELD: Model of endstage liverdisease; SBP: Spontaneous bacterial peritonitis; TIPS: Transjugular intrahepatic portosystemic shunt.

Table 3 Univariate regression analysis for prediction of segmental intrahepatic cholestasis

Variable	OR	Univariate 95%CI	P value
Age	0.96	-0.1 - 0.1	0.40
Male gender	0.78	-2.6 - 2.1	0.83
Other than alcoholic cirrhosis	0.54	-2.9 - 1.7	0.60
RVB as TIPS indication	< 0.01	-5654.8 - 5620.0	0.99
TIPS placement other than MHV-RPV	21.0	0.7 - 5.4	0.01

RVB: Recurrent variceal bleeding; MHV: Medial hepatic vein; RPV: Right portal branch.