ArticleJHEP reports : innovation in hepatology2025
Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis.
Article in JHEP reports : innovation in hepatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Preventing First and Further Decompensation in Advanced Chronic Liver Disease.Liver international : official journal of the International Association for the Study of the Liver · 2026Review
- Should Elective TIPS be Placed in Non-Abstinent Patients With Alcohol-Related Cirrhosis?United European gastroenterology journal · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
35 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background & Aims: Severe alcohol-related hepatitis (AH) and acute variceal bleeding (AVB) may occur simultaneously. The impact of a pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) in high-risk patients (patients with Child-Pugh (CP) B and active bleeding or CP C10-13 cirrhosis) with AVB and concomitant severe AH is unknown. The objective of the study was to compare the outcomes of severe AH in patients with high-risk AVB treated with pTIPS or endoscopic and drug treatment (Endo+drugs). Methods: Patients were screened in four existing cohorts of patients with cirrhosis and AVB treated either with pTIPS or Endo+drugs. The inclusion criteria were AVB, high-risk patients, suspected severe AH (recent onset of jaundice, alcohol-related liver disease, absence of abstinence, model for end-stage liver disease score >20 and aspartate aminotransferase <500 UI/L). The primary endpoint was 42-day mortality, considering liver transplantation as a competing event. Secondary endpoints were rebleeding and further development of ascites or hepatic encephalopathy at 6 months. Results: A total of 142 patients with AVB were included (pTIPS: n = 47, Endo+drugs: n = 95). Baseline characteristics (age 53, male sex 84%, model for end-stage liver disease score 23.4) were similar between the two groups. Overall, 56% had histologically proven AH. The 42-day mortality was 16% in the pTIPS group Conclusions: In severe AH, pTIPS is associated with better outcomes than Endo+drugs, and should not be contraindicated. Impact and implications: Severe alcohol-related hepatitis and acute variceal bleeding may occur concomitantly, yet the role of pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) placement in this setting remains unclear. In this study, compared to standard of care, pTIPS treatment was associated with lower mortality, although this difference did not reach statistical significance, as well as a significantly reduced risk of rebleeding and recurrent ascites. These findings suggest that severe alcohol-related hepatitis should not be viewed as a contraindication to pTIPS placement when otherwise indicated, such as in patients with Child-Pugh B cirrhosis with a score greater than 7 and active bleeding, or Child-Pugh C10-13 disease.
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