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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(03): 618-622
DOI: 10.1055/s-0041-1736403
Case Series

Beyond MELD Predictors of Post TIPSS Acute Liver Failure the Lesson Learned

Ritu Verma
1   Department of Radio-Diagnosis, Max Super specialty Hospital and Max Institute of Cancer Care, Vaishali, Ghaziabad, Uttar Pradesh, India
,
Nishchint Jain
2   Argim Group of Neurosciences, Artemis Hospital, Gurugram, Haryana, India
,
Abhishek Arora
3   Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Shivanand Gamangatti
3   Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Shailendra Chaturvedi
1   Department of Radio-Diagnosis, Max Super specialty Hospital and Max Institute of Cancer Care, Vaishali, Ghaziabad, Uttar Pradesh, India
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Abstract

TIPSS is safe and effective procedure for relieving portal hypertension by creating a low resistance portosystemic shunt. TIPSS reduces portal perfusion by 80 to 100% which then gradually gets partially compensated by increased flow from hepatic artery. Post TIPSS liver function shows brief deterioration which tends to start recovering in few weeks. However, progressive liver failure requiring emergency transplant or death remains a serious concern after TIPSS creation. The causes of post TIPSS liver failure are diverse and difficult to predict. Due to its rarity the definition of post TIPSS liver decompensation is also not well described in literature. Till date MELDNa score has been considered as the most reliable predictor of post TIPSS liver decompensation. In common practice post TIPSS liver failure is less likely in patients with model for end-stage liver disease (MELD) score less than 18. We have experienced two unusual cases of post-TIPSS liver failure (PTLF) in patients with initial acceptable/low MELD score and the importance of non-MELD factors that may negatively influence post TIPSS outcome. Most of these can be routinely investigated prior to creating shunt thereby identifying patients at high risk of developing PTLF.

Keywords

acute liver failure - hepatic encephalopathy - PTLF - TIPSS

Financial Support and Sponsorship

Nil.




Publication History

Article published online:
13 November 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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