Bañares R et al. (2005) Patients with cirrhosis and bare-stent TIPS may have increased risk of hepatocellular carcinoma. Hepatology 41: 566–571

Hepatocellular carcinoma (HCC) is a major cause of death in patients with cirrhosis, but risk factors for its development have not been fully defined. It has been suggested that the TIPS procedure might contribute to development of HCC because it results in physical effects similar to those resulting from surgical shunting, a procedure that has been associated with HCC in some studies. This retrospective study of two groups of patients (with and without bare-stent TIPS) assessed the relative risk of HCC development.

Patients' records were evaluated if they had at least 6 months of follow-up, with diagnosis of HCC during the surveillance period being the primary endpoint. Patients in the TIPS cohort were significantly more likely to develop HCC than patients in the non-TIPS cohort (adjusted hazard ratio 1.52, P = 0.02). This increase in risk was independent of secondary intervention to improve shunt function. Age >57 years and cirrhosis resulting from infection with hepatitis C virus were independently associated with HCC onset, but these associations were statistically insignificant.

The mechanisms underlying the increased risk of HCC development in the TIPS group were not elucidated in this study. The use of polytetrafluoroethylene-covered stents rather than bare stents might improve outcome, because changes in blood flow after shunt placement have been associated with hyperplasia, and covered stents might result in better control of portal hypertension. The authors also suggest that patients with TIPS should be screened more frequently in order to detect HCC development at an earlier stage.