Hepatocellular carcinoma in cirrhotic patients with transjugular intrahepatic portosystemic shunt: A retrospective case–control study

BackgroundAn association between Transjugular Intrahepatic Porto-Systemic Shunt (TIPS) and the development of hepatocellular carcinoma in patients with cirrhosis has been suggested, but not confirmed.AimTo evaluate the potential role of TIPS in hepatocellular carcinoma development.MethodsWe performed a retrospective case–control study among patients with cirrhosis; all cases had undergone TIPS placement. Cases and controls were followed as outpatients at a single liver care centre in the same timeframe.ResultsOverall, 101 patients with cirrhosis (mean age 58 ± 9 years, 64.3% male) were included in each group. Median duration of follow-up was 56.7 months (range 8.2–174.5) for TIPS patients and 67.8 months (range 8.3–183.1) for controls (p = 0.08). In both groups 94% of patients had Child–Pugh Class A or B cirrhosis. The cumulative incidence of hepatocellular carcinoma at 1, 3, 5, and 10 years was 2%, 7%, 18%, and 46% among TIPS patients, and 3%, 10%, 19%, and 39% among controls (log rank test p = 0.19). Compared to controls, hepatocellular carcinoma nodules in TIPS patients were more frequently situated in the right lobe (p < 0.05).ConclusionsTIPS does not seem to increase the risk of hepatocellular carcinoma in patients with Child–Pugh Class A or B cirrhosis; for these patients ultrasound surveillance should not be modified.