Molecular targeted therapy causes hepatic encephalopathy in patients after Transjugular intrahepatic portosystemic shunt (TIPS): A case report and literature review

We report two cases of hepatic encephalopathy caused by molecular targeted drugs after the Transjugular intrahepatic portosystemic shunt (TIPS) procedure in our center. The liver toxicities and anti-angiogenic effects induced by targeted drugs may generate an imbalance in ammonia metabolism, elevating blood ammonia levels. TIPS diverts partial blood supply from the liver, aggravates liver impairment, and shunts ammonia-rich blood from the intestine into the systemic circulation. These may be the mechanisms leading to hepatic encephalopathy caused by molecular targeted drugs following TIPS. When clinicians choose molecular targeted therapy as the second or third targeted therapy for patients who have undergone TIPS, the consequence of drug-induced hepatic encephalopathy should also be considered.