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Acute propranolol administration effectively decreases portal pressure in patients with TIPS dysfunction

Hepatic Hemodynamic Laboratory, Liver Unit, IMD, Hospital Clínic, Institut d’Investigacions Biomédiques August Pi I Sunyer, University of Barcelona, Spain

Correspondence to:
Correspondence to:
J Bosch, Hepatic Hemodinamic Laboratory, Liver Unit, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain; jbosch{at}clinic.ub.es

Background and aims: Up to 60% of patients treated with transjugular intrahepatic portosystemic shunt (TIPS) require angioplasty or restenting during the first year of follow up because of TIPS dysfunction (stenosis of the intrahepatic shunt increasing the portal pressure gradient above the 12 mm Hg threshold). We hypothesised that in patients with TIPS stenosis, propranolol administration, by decreasing portal inflow, would markedly decrease portal pressure.

Patients and methods: Eighteen patients with TIPS dysfunction were investigated by measuring portal pressure gradient before and after acute propranolol administration (0.2 mg/kg intravenously; n=18).

Results: Propranolol markedly reduced the portal pressure gradient (from 16.6 (3.5) to 11.9 (4.8) mm Hg; p<0.0001), cardiac index (-26 (7)%), and heart rate (-18 (7)%) (p<0.0001). Portal pressure gradient decreased to less than 12 mm Hg in nine patients, more frequently in those with moderate dysfunction (portal pressure gradient 16 mm Hg) than in patients with severe dysfunction (portal pressure gradient >16 mm Hg) (8/10 v 1/8; p=0.015).

Conclusions: Propranolol therapy may delay the increase in portal pressure and reduce the need for reintervention in patients with TIPS dysfunction.

Keywords: portal hypertension; liver cirrhosis; variceal bleeding; transjugular intrahepatic portosystemic shunt

Abbreviations: PPG, portal pressure gradient; HBF, hepatic blood flow; HR, heart rate; TIPS, transjugular intrahepatic portosystemic shunt; CI, cardiac index