Figure 1.

Possible scenarios after second or further decompensation in patients with liver cirrhosis treated with medical therapy versus TIPS placement with a view to transplantation. Red boxes indicate possible negative events and the progression of liver diseases. Grey boxes indicate potential causes of a patient’s exclusion from transplantation or death. Patients with decompensated liver cirrhosis undergoing medical or endoscopic therapy may experience clinical improvement, but the natural history of the disease may progress to further deterioration and a need for transplantation. Patients with TIPS can often develop hepatic encephalopathy, which is frequently transient, and seldom ACLF or cardiac deterioration. Some patients after a TIPS may correct portal thrombosis, making liver transplants more feasible. TIPS, by improving portal hypertension-related complications, may increase transplant-free survival. HE, hepatic encephalopathy; TIPS, transjugular intrahepatic portosystemic shunt, PH, portal hypertension; ACLF, acute-on-chronic liver failure; PV, portal vein.