Blood Flow Restriction Training After TIPS Placement in Liver Cirrhosis

Who can take part

• Age ≥ 18 years
• Diagnosis of liver cirrhosis of any etiology, confirmed by clinical, imaging, or histological criteria
• Successful TIPS placement for standard clinical indications (e.g., refractory ascites or variceal bleeding)
• Clinical stability 2-6 weeks after TIPS placement, defined as absence of acute complications requiring hospitalization
• Child-Pugh class A or B cirrhosis; selected individuals with Child-Pugh C may be included at investigator discretion
• No evidence of overt hepatic encephalopathy grade ≥ II at screening
• Ability to ambulate independently (with or without walking aid)
• Ability to understand study procedures and provide written informed consent
• Medical clearance by treating hepatologist to participate in moderate physical activity

Who cannot take part

• Active or recurrent hepatic encephalopathy grade II or higher within 4 weeks prior to screening
• Acute gastrointestinal bleeding within 14 days prior to enrolment
• Uncontrolled infection or sepsis
• Severe cardiopulmonary disease limiting exercise capacity (e.g., NYHA class III-IV heart failure, unstable coronary artery disease, severe pulmonary hypertension)
• Uncontrolled arterial hypertension (>180/110 mmHg)
• Severe orthopaedic, neurologic, or musculoskeletal conditions precluding participation in an exercise program
• Advanced hepatocellular carcinoma or other active malignancy with life expectancy < 6 months
• Model for End-Stage Liver Disease (MELD) score > 22 at screening
• Any condition which, in the opinion of the investigator, makes participation unsafe or not in the best interest of the participant
• Any contra-indication for MRI scanning
• Current alcohol or substance abuse interfering with study adherence
• Participation in another interventional clinical trial that may interfere with study outcomes
• Pregnancy or breastfeeding
• Regular participation in sports or physical activities for more than 2 hours per week
• Individuals who do not wish to be informed about unexpected medical findings
• Non-German-speaking