Publication

Abstract : Background Transjugular intrahepatic portosystemic shunt (TIPS) is an important therapeutic option for Budd-Chiari syndrome (BCS), but long-term data are limited. Aim Evaluate response rates, long-term outcomes, complications, and predictors of mortality, new decompensation, hepatic encephalopathy (HE), and restenosis after TIPS. Methods Retrospective analysis of symptomatic BCS patients who underwent TIPS at three centers in India (2010–2025) from a prospectively maintained database. We evaluated response rates, new decompensations (HE, variceal bleed, ascites), restenosis and survival outcomes and their predictors. Results Among 318 patients (mean age 29.4 ± 9.8 years, 50.6 % males, median follow-up 4.4 years), 244 (76.7 %) had a clinical response to TIPS; non-response (23.3 %) was mainly persistent ascites (two re-bleeds). Of 282 with ascites at presentation, complete/partial resolution at 3-months was 75.2 %/17.0 %. New decompensation developed in 32.7 %, HE in 14.8 %, and restenosis in 33.6 %. Transplant-free survival at 1, 5, and 10 years were 95.5 %, 87.4 %, and 78.4 %, respectively. Predictors of mortality included non-response to TIPS, bilirubin, albumin, and HE at 3 months. Age, non-response to TIPS, creatinine, and albumin predicted new decompensation. Post-TIPS complications occurred in 8.2 %. Conclusion TIPS is a safe, effective intervention for symptomatic BCS, leading to high response rates and long-term survival. Non-response to TIPS and liver function identifies high-risk patients who should be evaluated for transplantation.