The Impact of Transjugular Intrahepatic Portosystemic Shunt on Recompensation in Patients With Decompensated Liver Cirrhosis

The traditional view holds that the natural course of cirrhosis is a unidirectional process, characterized by irreversible progression from the compensated stage to the decompensated stage, and is highly likely to develop further decompensation events or even death. However, a growing body of evidence suggests that the natural course of cirrhosis is not always unidirectional - after the removal of the etiology, the structural and functional changes of the liver may be partially reversed. This understanding has given rise to the concept of "liver recompensation," which has been standardized at the Baveno VII Consensus Conference. Notably, in a cohort of patients with alcohol-related cirrhosis, 18% achieved recompensation, which was significantly associated with a reduction of more than 90% in liver-related mortality. In patients with hepatitis B-related cirrhosis, 6% achieved recompensation after treatment with nucleos(t)ide analogs, with a similar improvement in mortality. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established therapy for complications related to portal hypertension, including gastroesophageal variceal bleeding, refractory ascites, and hepatic hydrothorax. Compared with standard treatment, TIPS has been proven to reduce the incidence of further decompensation and improve transplant-free survival. However, due to portal blood shunting, the risks of abnormal liver function and hepatic encephalopathy (HE) also increase. It is worth noting that TIPS is not included in the definition of recompensation in the Baveno VII Consensus. Therefore, whether patients with cirrhosis who undergo TIPS treatment can achieve recompensation and which factors determine the probability of recompensation remain unknown. More importantly, the impact of recompensation on the risk of HCC development and mortality in TIPS patients has not been studied prospectively.

NCT Number	NCT07172035
Lead Sponsor	Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Collaborators: Zhongnan Hospital, Yichang Central People's Hospital, Jingzhou Central Hospital, Xiangyang Central Hospital, Jiangxi Provincial People's Hopital, The Central Hospital of Huanggang, Second Xiangya Hospital of Central South University, Shengjing Hospital, The First Affiliated Hospital with Nanjing Medical University, Shanxi Provincial People's Hospital, The First Affiliated Hospital of Zhengzhou University, The Third Xiangya Hospital of Central South University, Fujian Medical University Union Hospital, Renmin Hospital of Wuhan University
Conditions	Cirrhosis, Decompensation, Transjugular Intrahepatic Portosystemic Shunt (TIPS), Survival Analysis
Enrollment	250 participants
Start Date	2025-08-01
Primary Completion	2027-08-01 (estimated)
Study Completion	2027-08-01 (estimated)
Updated on ClinicalTrials.gov	2025-12-05