Pre‐ TIPS Liver and Spleen Volumetry Are Not Associated With Liver‐Related Outcomes After TIPS Placement for Refractory Ascites

BACKGROUND & AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) improves survival in refractory ascites. A careful patient's selection is mandatory as TIPS can lead to complications. Liver volumetry is predictive of outcomes before hepatic surgery, but data on its role before TIPS placement are scarce. We aimed to evaluate whether liver and spleen volume measurements are associated with prognosis after TIPS placement in patients with ascites. METHODS: We analysed data from three French centers, treated with TIPS between 2017 and February 2022. Inclusion criteria encompassed a TIPS placement for refractory or recurrent ascites and availability of cross-sectional imaging. Exclusion criteria included non-cirrhotic portal hypertension, other indications for TIPS, hepatocellular carcinoma beyond Milan criteria, and extrahepatic malignancy. Liver and spleen volumes were measured using pre-TIPS CT or MRI scans. The primary endpoint was 1-year transplant-free survival (TFS). Secondary endpoints were overt hepatic encephalopathy (HE), recurrence of ascites, acute variceal bleeding, and jaundice. RESULTS: The 160 patients were included (median age 60 years, male gender 83.8%, alcohol-related cirrhosis 58.8%, with active alcohol consumption in 25.6%, Child-Pugh B cirrhosis in 81.2%, median MELD score was 12). The 1-year TFS was 60.1%. Multivariate analysis identified serum creatinine (HR = 1.01 95% CI [1.00-1.01], p = 0.04), total bilirubin (HR = 1.02 95% CI [1.02-1.04], p = 0.004), and portal pressure gradient (HR = 1.09 95% CI [1.01-1.18], p = 0.03) as independent factors associated with TFS. Neither liver-to-spleen volume ratios (LSVR) (p = 0.36) nor liver volume index (p = 0.92) were significantly associated with death or LT. Overall, 38.1% of patients developed overt HE after TIPS, with lower platelet count (HR = 1.01 95% CI [1.00-1.01], p = 0.04) emerging as an independent predictor. No radiological characteristics were associated with the recurrence of ascites. CONCLUSIONS: In this multicenter study, liver and spleen volumes were not associated with transplant-free survival or liver-related outcomes in patients undergoing TIPS for ascites. These findings suggest that liver volumetry should not be a determining factor in patient selection for TIPS placement.