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TIPS and HCC: friends or foes?

Adriano de santis, Claudia Iegri and Stefano Fagiuoli

Portal hypertension and hepatocellular carcinoma [HCC] are major complications of liver cirrhosis and may coexist in the same patient. Transjugular intrahepatic portosystemic shunt [TIPS] is an effective treatment for recurrent variceal bleeding and refractory ascites although accumulating evidence has shown that its indication is gradually expanding. TIPS placement reduces portal flow by connecting splanchnic vessels to systemic circulation. As a consequence parenchymal portal venous flow is decreased so inducing an ischemic injury. In this condition, a possible activation of hepatic stellate cells, an induction of neoangiogenesis and an increase in secretion of HGF and VEGF may represent possible triggers for hepatocarcinogenesis. On these bases, several studies have explored a possible influence of TIPS on the onset of hepatocellular carcinoma [HCC] in cirrhotic patients. To date the results are controversial and the role of TIPS as risk factor for HCC is still unclear. Moreover, the diversion of portal flow and the onset of arterioportal shunts following TIPS insertion, may reduce the efficacy and the safety profile of transarterial treatments. Until now, very little evidence has been collected regarding this topic and the results are conflicting. Therefore, whether TIPS and hepatocellular carcinoma are either “Friends or Foes” is still an ongoing dilemma.