SIR Today

“We know that TIPS can be lifesaving, but we also see patients who deteriorate rapidly afterward,” said Jirapa Chansangrat, MD, the study’s presenting author and a former research fellow at Cleveland Clinic. “The question was whether we could catch that trajectory early enough to change it.” The study was directed by Sameer Gadani, MD, FSIR, Associate Professor and Research Director of Interventional Radiology at Cleveland Clinic, who designed the project as part of a broader effort to build an evidence base around TIPS outcomes.

The work draws on an IRB-approved TIPS registry at Cleveland Clinic, established and led by Dr. Gadani under the oversight of department chair Abraham Levitin, MD. Using this registry, the research team reviewed data from more than 950 patients who underwent TIPS placement at the institution between 2010 and 2022. Dr. Chansangrat, now on faculty at Suranaree University of Technology in Thailand, performed the data analysis. Amrit Khooblall, a medical student and research fellow in the department, coordinated data collection across the 12-year cohort.

The investigators recorded baseline demographics, pre-procedure clinical variables (including history of hepatic encephalopathy and spontaneous portosystemic shunts), and procedural details. Laboratory values including alanine transaminase (ALT) level and individual components of Model for End-Stage Liver Disease (MELD 3.0) scores and their variants were tracked at baseline; daily for the first week after the TIPS procedure; and at 1, 3, 6, and 12 months after the procedure. For each marker, the team captured the post-TIPS peak value, percentage change from baseline, time to peak, and time to return to baseline.

PTLF occurred in 169 patients (17.8% of the cohort). Baseline factors (such as age and history of hepatic encephalopathy) and dynamic post-TIPS patterns were found to be effective independent predictors of this complication. The investigators found that while pre-procedure characteristics can help to identify at-risk patients, dynamic laboratory markers are more powerful for early risk stratification. Specifically, a larger percentage change in ALT level and MELD 3.0 scores in the early post-procedure period emerged as significant predictors of PTLF. In addition, delayed recovery of ALT toward baseline after the post-TIPS peak was associated with an increased risk of early PTLF, suggesting that close monitoring in the first days after the procedure could fundamentally change how clinicians care for these patients.

“The most important finding is that dynamic laboratory changes matter more than the isolated baseline,” said Dr. Chansangrat. “While some enzyme elevation is expected after TIPS, patients who develop PTLF show a disproportionate rise in ALT and MELD 3.0. Those changes occur early—within the first few weeks—giving us a window to act.”

“If early labs show high-risk patterns, that information can be used to escalate care: involving hepatology colleagues sooner and, most importantly, initiating transplant evaluation earlier rather than waiting for irreversible decompensation,” Dr. Chansangrat said. “The natural outcome is better patient care.”

Dr. Levitin and Dr. Gadani emphasized the collaborative effort behind the findings. “This study is the product of years of investment in our TIPS registry and the talented team we’ve built in Cleveland Clinic Interventional Radiology,” they said. “From our research fellows and medical students to our faculty, every member has contributed to making this program a resource for advancing patient care. We’re committed to turning these findings into practical tools that improve outcomes for every patient who undergoes TIPS.”