Early liver parameter increase after transjugular intrahepatic portosystemic shunt (TIPS): hepatic vascular risk factors and development of an exploratory prediction model

Abstract Purpose To investigate early laboratory changes following Transjugular Intrahepatic Portosystemic Shunt (TIPS) and their associations with hepatic vessel diameters. Additionally, to develop a model to predict patients at high-risk for excessive liver parameter increase. Materials and methods A total of 256 TIPS procedures performed between 2017 and 2024 were retrospectively enrolled and divided into a development ( n = 208) and temporally separated internal validation cohort ( n = 48). Diameters of portal vein and hepatic arteries were measured in pre-procedural computed tomography scans. Laboratory parameters (INR, ALAT, ASAT, GGT, and bilirubin) were assessed pre-procedurally, on post-procedural days 1–2, and between days 4–7. Patients with ≥ 2 parameters exceeding the 85th percentile of percentage change on days 1–2 were classified as high-risk. A prediction model for the identification of high-risk patients was developed and validated. Results All laboratory parameters significantly increased post-procedurally ( p < 0.001), with 41 patients classified as high-risk. ALAT and ASAT showed the highest increase (up to +392 +/- 1118% and +474 +/- 1125%, respectively). Hepatic artery and portal vein diameters were predominantly negatively correlated with laboratory changes ( p < 0.05). The prediction model identified common hepatic artery diameter, portal vein thrombosis, and baseline bilirubin as independent high-risk predictors, achieving an AUC of 0.782 and 0.748 in the development and internal validation cohort, respectively. Conclusion TIPS significantly impacts liver metabolism, with marked early alterations in liver parameters that inversely correlate with hepatic vessel diameters. A prediction model based on common hepatic artery diameter, portal vein thrombosis status, and baseline bilirubin may support identification of high-risk patients and potentially help optimize post-procedural management.