Tailoring Post-TIPS Hemodynamic Targets to Clinical Indications: Variceal Bleeding vs. Refractory Ascites

Section snippets

Adjustments to PPG During the Second Measurement

Zipprich et al. note that adjustments to the portal pressure gradient (PPG) in our cohort were limited to cases of suboptimal stent positioning or stenosis/occlusion, rather than PPG exceeding the target range. This approach aligns with the primary objective of our study: to identify optimal timing and hemodynamic targets for PPG measurement post-TIPS, not to evaluate intervention efficacy^[1]. To preserve the natural trajectory of PPG evolution and avoid confounding effects, we deliberately

Discrepancy in Outcomes with the 7–14 mmHg Target Range

Zipprich et al. report no survival or decompensation differences using a 7–14 mmHg target in their cohort (n=84), contrasting with our findings. Two factors likely explain this divergence: a) Population Heterogeneity: Our cohort exclusively included patients with variceal bleeding, whereas Zipprich et al. enrolled a mixed population (71% refractory ascites). These groups exhibit distinct hemodynamic profiles. For bleeding, excessive PPG reduction (<10 mmHg) risks hepatic encephalopathy (OHE)

Authors' contributions

Yong Lv, Zhengyu Wang, Bohan Luo and Guohong Han designed the letter; Yong Lv drafted the letter; Guohong Han revised the letter.

Financial support

None.

Declaration of Competing Interest

All authors have nothing to declare.Please refer to the accompanying ICMJE disclosure forms for further details.

Acknowledgements

None.