The impact of trans-jugular intrahepatic portosystemic shunts on muscle mass in chronic liver disease.

Adult patients with cirrhosis who have been referred for a trans-jugular, intrahepatic portosystemic shunt (TIPS) for clinical indications by their treating physician will be approached for participation in this research study. Baseline measures will be obtained prior to TIPS. These measures will be repeated at 3 months and 6 months after TIPS to assess changes in body composition. The trial will involve 6 months of follow up after TIPS. Enrolment: A single slice from the third lumbar vertebrae will be used for a CT performed prior to TIPS (as part of standard of care). This will be analysed for lean muscle mass, subcutaneous adipose tissue and visceral adipose tissue using dedicated computer software. At each appointment (baseline prior to TIPS, 3 months and 6 months post TIPS) Physical assessments (short Physical performance battery and fried frailty index) and clinical history and examination will also be performed (30 minutes). Patients will undergo blood tests (10minutes) and a test of cognitive function, Stroop Test (10minutes). Prior to undergoing TIPS, patients will have had a CT abdomen performed to assist with TIPS planning as part of standard of care. A single slice of this scan at L3 level will be analysed using dedicated software to estimate lean muscle mass and visceral and subcutaneous adipose tissue. A further L3 single slice CT scan will be performed at 6 months after TIPS to assess for changes in these parameters (15min).