Role of spleen stiffness measurement by vibration-controlled transient elastography at 100Hz in guiding invasive hemodynamic reassessments after underdilated TIPS.

Underdilated Transjugular Intrahepatic Portosystemic Shunt (udTIPS) effectively manages portal hypertension complications while minimizing shunt-related adverse events. Spleen Stiffness (SS) measured by vibration-controlled transient elastography has shown high accuracy in detecting clinically significant portal hypertension when compared to the gold standard hepato-venous pressure gradient. To evaluate SS as a non-invasive tool for identifying patients with Porto-Caval Pressure Gradient (PCPG) <12 mmHg after udTIPS. We prospectively enrolled patients with cirrhosis undergoing udTIPS at our referral center (January 2023–September 2024). Both invasive PCPG assessment and SS measurement with the spleen-dedicated 100Hz probe by FibroScan® were performed at three time-points: before TIPS, immediately post-TIPS, and one-month after the procedure. The study included 51 patients (mean age 62±12 years, 63% male) with preserved liver function [median Child-Pugh score 7 (IQR 3), MELD-Na 13 (IQR 6)]. TIPS indications were secondary prophylaxis for variceal bleeding (65%) and refractory ascites (35%). Median udTIPS dilation diameter was 6 (IQR 1) mm. PCPG progressively decreased from 22 (IQR 7) pre-TIPS to 15 (IQR 4) immediately post-TIPS and 11 (IQR 5) mmHg at one-month. Correspondingly, SS decreased from 74.5 (IQR 5) to 55.5 (IQR 21) and 41.6 (IQR 19) kPa. All SS measurements strongly correlated with PCPG values (ρ=0.72, p<0.0001). SS demonstrated an excellent diagnostic discrimination for PCPG <12 mmHg [AUC=0.90 (95% CI 0.84-0.96)]. The cut-off of <35 kPa accurately ruled in patients with post-TIPS PCPG <12 mmHg (97.8% specificity, 88.2% PPV, 21.3 positive likelihood ratio). SS measured with the spleen-dedicated 100Hz probe strongly correlates with PCPG over time and reliably identifies patients achieving PCPG <12 mmHg after udTIPS. If validated in larger cohorts, SS may become a non-invasive tool for tailoring invasive hemodynamic reassessments in post-TIPS monitoring protocols. [ABSTRACT FROM AUTHOR]