105 - Effect of Portal Dominant Post-TIPS Pressure Gradient Reduction on Outcomes in Patients with Recurrent Ascites

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Poster Presenter(s)

Kevan Ip (he/him/his)

Medical Student
Sidney Kimmel Medical College, Thomas Jefferson University, United States

Author/Co-author(s)

PY

Peter Yang, BS

Medical Student
Sidney Kimmel Medical College, Thomas Jefferson University, United States
Kevin Anton, MD, PhD (he/him/his)

Assistant Professor of Radiology
Thomas Jefferson University Hospital, United States
SL

Stephan Leung, MD

Assistant Professor of Radiology
Thomas Jefferson University Hospital, United States

Purpose: Refractory ascites requiring frequent paracenteses poses a significant challenge to quality of life for patients with portal hypertension. The transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is performed to reduce the portosystemic gradient to decrease the amount and frequency of paracentesis. This study aims to identify the impact of proportional changes in right atrial (RA) and portal vein (PV) pressures on clinical outcomes after TIPS.

Materials and Methods: All patients undergoing TIPS for refractory ascites at a single institution from May 2017 to August 2023 were retrospectively reviewed. Data included age, sex, liver disease, paracentesis frequency and volume during three months before and after TIPS, and measurements for right atrial and portal venous pressures pre- and post-TIPS. TIPS procedures were stratified by whether they had an 50% increase in PV (“PV dominant”) or a 50% decrease in RA pressure (“RA dominant”) relative to transinusoidal p</span>ressure change. Differences in paracentesis volume and frequency were assessed by Student’s t-test.

Results: We identified 41 patients who underwent TIPS (median age = 56). PV vs RA dominant changes in transinusoidal gradient did not significantly predict 1 month or 3 month outcomes of paracentesis volume or frequency. RA dominant change was associated with a mean 1-month paracentesis volume reduction of 72%, whereas PV dominant change was associated with a 62% reduction (p=0.45). Similarly, RA dominant change was associated with an 80% reduction in frequency of paracentesis procedures over 3 months, whereas PV dominant change was associated with 44% reduction (p=0.28).

Conclusion: Patients with either greater than 50% change in right atrial pressure versus 50% change in portal venous pressure did not show a statistically significant association with outcomes as measured by paracentesis frequency and volume at 1 and 3 months. Our findings suggest that the difference in right atrial or portal venous pressure dominant changes does not contribute significantly to outcomes of patients receiving TIPS for refractory ascites.