(Vienna, 09 July 2026) – The implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is used in people with advanced liver cirrhosis to treat complications arising from increased pressure in the portal vein, such as accumulation of abdominal fluid (ascites) or internal bleeding (most commonly from oesophageal varices). Researchers at the Medical University of Vienna, in collaboration with collaborators at Johannes Gutenberg University Mainz, have now identified certain biological changes following TIPS implantation that are associated with the subsequent course of liver disease. Their study findings, recently published in the journal "Liver International", facilitates personalized care in patients after TIPS.
The study focused on von Willebrand factor (VWF), a protein in the blood that is involved, amongst other things, in blood clotting and is considered a marker for abnormal changes in the inner wall of blood vessels. Elevated VWF levels are frequently observed in people with liver cirrhosis. Until now, however, it was unclear whether changes in this level following TIPS implantation could provide information about the subsequent prognosis.
To investigate this question, data from 199 patients in Vienna and Mainz were analysed. For 118 individuals, VWF measurements were available both before the procedure and three months afterwards. The analysis revealed that VWF levels in the overall group fell from 313 to 262 per cent. In almost half of patients, there was a clinically relevant decrease, i.e. as previously defined by ≥5%. Importantly, it was not the baseline value prior to the procedure that was decisive, but rather its subsequent trend. Patients with a decrease in VWF had a significantly lower mortality rate than those without such a decrease, specifically after one year, the mortality was 4.2 % vs. as high as 21.1 % among patients without a decrease in VWF. This association remained even after accounting for established risk factors of mortality such as age and the severity of liver disease.
Changes in markers provide insights into prognosis
In addition, the research team investigated the dynamics of the inflammatory marker interleukin-6 (IL-6). Combining both markers enabled further risk stratification. Patients in whom both VWF and IL-6 declined within three months of TIPS had the most favourable prognosis. In this group, the two-year mortality rate was 10.6 %. In contrast, among those in whom neither marker declined, the mortality rate was as high as 46.7 %.
"Our findings show that it is not individual baseline values prior to the procedure, but rather their course in the first few months afterwards, that can provide important insights into the further course of the disease," says study first author Marlene Hintersteininger (Division of Gastroenterology and Hepatology, Department of Medicine III, MedUni Vienna). "As von Willebrand factor testing is already available in clinical practice, this information could help to provide more targeted care for patients following TIPS implantation in future." The study lead and corresponding author Dr. Lukas Hartl adds: "While the results are very promising and can inform clinical practice – because VWF and IL-6 are readily available biomarkers and can provide a valuable guidance for patient management after TIPS." In the long term, and upon further validation, monitoring changes in VWF and IL-6 levels should be widely implemented in order to identify high-risk patients earlier following TIPS implantation.
Interdisciplinary patient management at MedUni Vienna
A transjugular intrahepatic portosystemic shunt (TIPS) is an artificially created connection between the portal vein and a hepatic vein. This reduces the elevated pressure in the portal vein, which in advanced liver cirrhosis can lead to complications such as ascites or variceal haemorrhage. TIPS is now considered an integral part of the treatment of selected patients with advanced liver cirrhosis and portal hypertension.
At the Medical University of Vienna, potential TIPS candidates are managed through a collaboration between the Division of Gastroenterology and Hepatology, Department of Medicine III, and the Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy (coordinated by Maria Schoder and Lukas Reider). The close collaboration between the two departments is particularly evident in the interdisciplinary PH/TIPS Board (Hepatology Lead: Thomas Reiberger), where cases of patients with complications of portal hypertension are discussed and well-informed, evidence-based treatment recommendations are formalized.
Publication: Liver International
Post-TIPS Dynamics of von Willebrand Factor for Risk Stratification After TIPS Placement
Marlene Hintersteininger, Simon Johannes Gairing, Katrin Kirsch, Theresa Müllner-Bucsics, Susanna Riegler, Lukas Reider, Mathias Jachs, Lorenz Balcar, Eva M. Schleicher, Jasmin Söhngen, Lukas Müller, Michael B. Pitton, Julia Weinmann-Menke, Christian M. Lange, Peter R. Galle, Michael Trauner, Mattias Mandorfer, Thomas Reiberger, Christian Labenz, Lukas Hartl
https://onlinelibrary.wiley.com/doi/10.1111/liv.70736