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Semin Liver Dis 2023; 43(02): 189-205
DOI: 10.1055/a-2107-0576
Review Article

To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and Acute-on-Chronic Liver Failure

Wenyi Gu
1   Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany
2   Medical Department I, Frankfurt University Hospital, Frankfurt am Main, Germany
,
Markus Kimmann
1   Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany
,
Wim Laleman
1   Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany
3   Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic Disorders, University Hospitals Leuven, KU Leuven, Leuven, Belgium
,
Michael Praktiknjo
1   Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany
,
Jonel Trebicka
1   Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany
4   European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
5   Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
› Institutsangaben
Funding This study was supported by the German Research Foundation (DFG) project ID 403224013–SFB 1382 (A09), by the German Federal Ministry of Education and Research (BMBF) for the DEEP-HCC project and by the Hessian Ministry of Higher Education, Research and the Arts (HMWK) for the ENABLE and ACLF-I cluster projects. The MICROB-PREDICT (project ID 825694), DECISION (project ID 847949), GALAXY (project ID 668031), LIVERHOPE (project ID 731875), and IHMCSA (project ID 964590) projects have received funding from the European Union's Horizon 2020 research and innovation program. The manuscript reflects only the authors' views, and the European Commission is not responsible for any use that may be made of the information it contains. The funders had no influence on study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Abstract

Variceal bleeding is a consequence of severe portal hypertension in patients with liver cirrhosis. Although the rate of bleeding has decreased over time, variceal bleeding in the presence of acute-on-chronic liver failure (ACLF) carries a high risk of treatment failure and short-term mortality. Treatment and/or removal of precipitating events (mainly bacterial infection and alcoholic hepatitis) and decrease of portal pressure may improve outcome of patients with acute decompensation or ACLF. Transjugular intrahepatic portosystemic shunts (TIPSs), especially in the preemptive situation, have been found to efficiently control bleeding, prevent rebleeding, and reduce short-term mortality. Therefore, TIPS placement should be considered as an option in the management of ACLF patients with variceal bleeding.

Keywords

TIPS - acute-on-chronic liver failure - variceal bleeding - systemic inflammation


Publikationsverlauf

Accepted Manuscript online:
07. Juni 2023

Artikel online veröffentlicht:
05. Juli 2023

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