No Foul Play for Transjugular Intrahepatic Portosystemic Shunts in Liver Transplantation for Hepatocellular Carcinoma.

Transjugular intrahepatic portosystemic shunt (TIPS) can be placed to treat or prevent complications of portal hypertension in patients with cirrhosis, yet little is known about the effects of TIPS placement on diagnosis or liver transplant (LT) outcomes in patients with hepatocellular carcinoma (HCC). We read with interest the recent retrospective analysis from Krumeich et al. suggesting that the presence of TIPS may alter radiographic HCC visualization, leading to under-staging and underdiagnosis of HCC - or occult disease - prior to LT (1). Previous studies have suggested in-vivo alteration of hepatic parenchymal blood flow, increased arterial perfusion, and decreased portal venous perfusion in cirrhotic patients with TIPS (2,3) as potential contributory mechanisms to Krumeich et al.'s recently published findings.