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Group of Michael Schultheiß and Dominik Bettinger

Research interest

Chronic liver damage leads to fibrosis and finally liver cirrhosis. Patients with cirrhosis often suffer from symptoms of portal hypertension, namley ascites and/or variceal bleeding. Importantly, symptomatic portal hypertension is associated with increased morbidity and mortality. Medical and/or endoscopic treatment as well as implantation of transjugular intrahepatic portosystemic shunt (TIPS) are well-established therapies in these patients.

Moreover, liver cirrhosis is the main predisposing factor concerning development of hepatocellular carcinoma (HCC).

In our group we focus on clinical aspects of TIPS implantation and hepatocellular carcinoma. Currently our research topics are:

  • TIPS implantation in HCC patients
  • Clinical management of HCC
  • Clinical management of symptomatic portal hypertension 
  • Development of prognostic scores for patients with TIPS implantation

With regrad to the last topic we have established an alternative risk score for patients with TIPS implantation. This newly developed score (Freiburg index of post TIPS survival) accurately identifies patients with a high risk for reduced survival.


Group leaders

Dr. Michael Schultheiß michael.schultheiss@uniklinik-freiburg.de 0761/270-34010
PD Dr. Dominik Bettinger dominik.bettinger@uniklinik-freiburg.de 0761/270-34010

Group members

Prof. Dr. Martin Rössle    
Jan Patrick Huber patrick.huber@uniklinik-freiburg.de 0761/270-34010
Dr. Marlene Reincke marlene.reincke@uniklinik-freiburg.de 0761/270-34010
Dr. Lukas Sturm lukas.sturm.med@uniklinik-freiburg.de 0761/270-34010
Chiara Gahm (MD student)    
Laura Muller (MD student)    
Lena Pfaff (MD student)    
Lisa Roth (MD student)    
Lara Volkwein (MD student)    

Selected publications

Bettinger D., Knüppel E., Euringer W., Spangenberg HC, Rössle M., Thimme R., Schultheiß M. Efficacy and safety of transjugular intrahepatic portosystemic shunt in 40 patients with hepatocellular carcinoma. Aliment Pharmacol Ther. 2015 Jan;41(1):126-36 


Bettinger D, Schultheiss M, Boettler T, Muljono M, Thimme R, Rössle M. Procedural and shunt-related complications and mortality of the transjugular intrahepatic portosystemic shunt (TIPSS). Aliment Pharmacol Ther. 2016Nov;44(10):1051-1061   


Bettinger D, Spode R, Glaser N, Buettner N, Boettler T, Neumann-Haefelin C, Brunner TB, Gkika E, Maruschke L, Thimme R, Schultheiss M. Survival benefit of transarterial chemoembolization in patients with metastatic hepatocellular carcinoma: a single center experience. BMC Gastroenterol.2017  Aug 10;17(1):98   


Bettinger D., Martin D., Rieg S., Schultheiss M., Buettner N., Thimme R., Boettler T. Treatment with proton pump inhibitors is associated with increased mortality in patients with pyogenic liver abscess. Aliment Pharmacol Ther. 2018 Mar;47(6):801-808


Bettinger D., Pinato DJ, Schultheiss M., ... Brunner TB, Gkika E. 

Stereotactic body radiation therapy as an alternative treatment for patients with hepatocellular carcinoma compared to sorafenib: a propensity score analysis. Liver Cancer [Epub ahead of print]


Bettinger D., Gkika E., Schultheiss M., Maruschke L., Glaser N., Buettner N., Kirste S., Nestle U., Groscu AL., Thimme R, Brunner TB. Comparison of local tumor control in patients with hepatocellular carcinoma treated with stereotactic body radiation or transarterial chemoembolisation: a propensity score analysis. BMC Cancer. 2018 Aug 9;18(1):807


Sturm L., Bettinger D., Giesler M., Boettler T., Schmidt A., Buettner N., Thimme R., Schultheiss M. Treatment with proton pump inhibitors increases the risk for development of hepatic encephalopathy after implantation of transjugular intrahepatic portosystemic shunt (TIPS); United European Gastroenterol J. 2018 Nov;6(9):1380-1390 [geteilte Erstautorschaft]


Rössle M., Fritz B., Blanke P., Schultheiß M., Bettinger D. 

Free hepatic vein pressure is not useful to calculate the portal pressure gradient in cirrhosis: a morphological and hemodynamic study. J Vasc Interv Radiol. 2016Aug;27(8):1130-7


Schultheiss M., Giesler M., Schmidt A., Sturm L., Thimme R., Rössle M., Bettinger D. Adjuvant transjugular variceal occlusion at TIPS implantation: efficacy and risks of bucrylate embolization. Cardiovasc Intervent Radiol. 2019 May;42(5):729-736


Pinato DJ, Yen C, Bettinger D, Ramaswami R, Arizumi T, Ward C, Pirisi M, Burlone ME, Thimme R, Kudo M, Sharma R.  The albumin-bilirubin grade improves hepatic reserve estimation post-sorafenib failure: implications for drug development. Aliment Pharmacol Ther. 2017 Mar;45(5):714-722


Waked I, Berhane S, Toyoda H, Chan SL, Stern N, Palmer D, Tada T, Yeo W, Mo F, Bettinger D, Kirstein MM, Iñarrairaegui M, Gomaa A, Vogel A, Meyer T, Sangro B, Lai P, Kumada T, Johnson PJ.  Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion. Br J Cancer. 2017 Feb 14;116(4):448-454


Geier A, Macias RI, Bettinger D, Weiss J, Bantel H, Jahn D, Al-Abdulla R, Marin JJ. The lack of the organic cation transporter OCT1 at the plasma membrane of tumor cells precludes a positive response to sorafenib in patients with hepatocellular carcinoma. Oncotarget. 2017 Feb 28;8(9):15846-15857 


Howell J, Pinato DJ, Ramaswami R, Bettinger D, Arizumi T, Ferrari C, Yen C, Gibbin A, Burlone ME, Guaschino G, Sellers L, Black J, Pirisi M, Kudo M, Thimme R, Park JW, Sharma R. On-target sorafenib toxicity predicts improved survival in hepatocellular carcinoma: a multi-centre, prospective study. Aliment Pharmacol Ther. 2017 Apr;45(8):1146-1155.


Mollaiyan A, Bettinger D, Rössle M. The underdilation of nitinol stents at TIPS implantation: Solution or illusion? Eur J Radiol. 2017 Apr;89:123-128 


Gkika E, Schultheiss M, Bettinger D, Maruschke L, Neeff HP, Schulenburg M, Adebahr S, Kirste S, Nestle U, Thimme R, Grosu AL, Brunner TB. Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma. Radiat Oncol. 2017 Jul 12;12(1):116.


Yen C., Sharma R. , Rimassa L. ,  Arizumi T,  Bettinger D., Choo HY,  Pressiani T, Burlone ME,  Pirisi M, Giordano L,  Abdulrahman A, Kudo M, Thimme R, Park JW,  Pinato DJ. Treatment-stage migration maximizes survival outcomes in patients with hepatocellular carcinoma treated with sorafenib. Liver Cancer. 2017 Nov;6(4):313-324