Liver Cirrhosis (Decompensated)

What is TIPS?

Transjugular intrahepatic portosystemic shunt creates an artificial channel through liver tissue between the portal and hepatic veins, decompressing portal hypertension. It treats variceal bleeding and refractory ascites without surgery.

Why China?

• High experience: Xijing and PUMC perform 200-400 TIPS/year
• Cost: $7,500-$12,000 vs. $30,000-$60,000 in the US
• Covered stents standard: Viatorr ePTFE stent grafts reduce shunt dysfunction
• Bridge to transplant: Coordinated with LDLT programs

Who is a candidate?

• Refractory variceal bleeding despite endoscopic therapy
• Refractory ascites requiring repeated paracentesis
• Hepatic hydrothorax
• Budd-Chiari syndrome
• MELD <18 (higher risk above this)

Outcomes

Variceal rebleeding: <15% at 1 year (vs 50% endoscopic alone). Ascites response: 60-80%. Hepatic encephalopathy: 25-35% (manageable). 1-year survival: 70-85% depending on MELD.