1B). However, there was an abrupt truncation of the native common hepatic artery with compromised flow to the right lobe of the liver (Fig, 1C,D, white arrow). This finding suggests that the hepatic infarct was secondary to TIPS-related shunting of portal venous blood away from the liver, leaving the right lobe with minimal Wnt beta-catenin pathway blood supply from a compromised artery. Despite aggressive resuscitation, the patient remained hypotensive and died 5 days after TIPS placement. TIPS procedures are frequently used for the treatment of massive variceal bleeding and refractory ascites in patients with portal

hypertension.1 More recent data suggest that there may be benefit from the earlier use of TIPS in high-risk cirrhotics who present with variceal bleeding, which may make the use of TIPS even more commonplace.2 Liver infarction is a rare complication after TIPS placement. In 2002, Bureau et al. reported two cases of hepatic infarction after TIPS using polytetrafluoroethylene (PTFE)-covered PF-02341066 clinical trial stents.3

In both cases, the infarct was felt to be secondary to obstruction of venous outflow from the TIPS stent. In 2010, Vizzutti et al. reported on a case of segmental hepatic ischemia induced by a PTFE-coated stent.4 The patient developed acute liver failure, which gradually improved. Only one other case of fatal liver infarction has been reported after TIPS Interleukin-2 receptor placement.5 The patient developed the infarct after an episode of shock and disseminated intravascular coagulation. CT, computed tomography; PTFE, polytetrafluoroethylene; TIPS, transjugular intrahepatic portosystemic shunt. Our case is unique in that the patient had an abnormality in his common hepatic artery resulting in decreased blood flow to the right lobe of the liver. The truncation of the hepatic artery was likely a complication of his previous liver transplant surgery. Because of the emergent indication for the TIPS procedure and the lack of expertise

at our center, balloon occluded retrograde transvenous obliteration was not considered. The shunting of portal vein blood away from the liver after TIPS in the setting of a compromised arterial supply led to the liver infarction. This case stresses the importance of imaging before TIPS placement to ensure patency of the hepatic artery. Although it is a rare occurrence, physicians should be aware of this potentially dangerous complication. “
“We read with great interest the article by Kremer et al.,1 on the role of interleukin-12 (IL-12) production by Kupffer cells in fatty liver, and its possible impact in the reduction of hepatic resident natural killer T (NKT) cells using an animal model of hepatosteatosis (mice fed choline-deficient diet for 0-20 weeks).