Circulating extracellular vesicles predict outcome in patient undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement

Portal hypertension is a primary cause of complications leading to significant morbidity and mortality in patients with cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) insertion has improved survival in well-selected patients with refractory ascites and high-risk variceal bleeding. We investigated the prognostic role of circulating extracellular vesicles (EVs), which are known for their role in immunomodulation and intercellular communication, in patients undergoing TIPS. 141 patients undergoing TIPS placement were included in this retrospective analysis. Median EVs size (X50) and total serum concentration were determined by nanoparticle tracking analysis (NTA) prior to TIPS placement, and transplant-free 1-year survival was assessed using time-to event analysis and Cox regression. EVs size but not their concentration moderately correlated with MELD and Child–Pugh scores based on its correlation with bilirubin and international normalized ratio. In addition, a significant correlation of EVs concentration with platelet count and the immune activation marker soluble urokinase plasminogen activator receptor was observed. In univariate analysis, larger EVs size (> 243 nm) was associated with 1-year transplant-free survival after TIPS placement ( p  = 0.012; HR: 2.539), which remained significant after adjusting for MELD scores in multivariable Cox-regression analysis ( p  = 0.033; HR: 2.204). Larger EVs size indicates advanced stages of chronic liver disease and served as an independent predictor of transplantation-free survival after TIPS placement. Larger prospective studies are needed to confirm these findings and to identify patients at particularly high-risk following TIPS placement.