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Background <p>Transjugular intrahepatic portosystemic shunt (TIPS) is utilized to manage portal hypertensive complications in patients with decompensated cirrhosis. However, its effects on transplant candidacy and peri-operative outcomes remain unclear. We hence aimed to evaluate&#xa0;peri-transplant outcomes and&#xa0;implications of TIPS in liver transplant (LT) candidates.</p> Methods <p>We conducted a retrospective cohort study of adult LT candidates listed in the United Network for Organ Sharing (UNOS) database from January 1, 2000 to January 3, 2025. Waitlist outcomes include development of portal hypertension-related complications, time-to-transplant and waitlist survival. Post-transplant outcomes include graft survival and overall post-transplant survival. These outcomes were compared between patients with and without TIPS, and across disease etiologies among TIPS recipients.</p> Results <p>Among 169,681 waitlist registrants (19,940 with TIPS, 149,741 without TIPS), TIPS was associated with higher odds of portal vein thrombosis during waitlist (OR: 1.365, 95% CI: 1.270 to 1.467, p &lt; 0.001) and lower odds of ascites during waitlist (OR: 0.874, 95% CI: 0.818 to 0.934, p &lt; 0.001). TIPS recipients had significantly higher 90-day and 1-year time-to-transplant and waitlist survival, with minimal differences in graft survival and overall post-transplant survival. Among TIPS recipients, patients with alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease had significantly lower 90-day and 1-year time-to-transplant and higher 1-year waitlist survival compared to patients with hepatitis C.</p> Conclusion <p>TIPS is associated with improved waitlist survival and timely transplantation without negatively impacting post-transplant outcomes. These findings support the use of TIPS in a select group of patients with high burden of portal hypertensive complications.</p>

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Impact of Transjugular Intrahepatic Portosystemic Shunt on Waitlist and Post-transplant Outcomes in Liver Transplant Candidates

  • 期刊论文

  • 发表日期：

    2026年4月4日

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  • Ryan Yanzhe Lim,
  • Peter Jin Sun Low,
  • Wen Hui Lim,
  • Asvin Selvakumar,
  • Do Han Kim,
  • Nicole Shu Ying Tang,
  • Pojsakorn Danpanichkul,
  • Ethan Kai Jun Tham,
  • Hirokazu Takahashi,
  • Masahide Fujiyoshi,
  • Bryant Low,
  • Vincent L. Chen,
  • Karn Wijarnpreecha,
  • Meena Bansal,
  • Daniel Q. Huang,
  • Mazen Noureddin,
  • Mark Muthiah,
  • Mohammad Shadab Siddiqui,
  • Eunice Xiang-Xuan Tan,
  • Margaret LP Teng

摘要

Background

Transjugular intrahepatic portosystemic shunt (TIPS) is utilized to manage portal hypertensive complications in patients with decompensated cirrhosis. However, its effects on transplant candidacy and peri-operative outcomes remain unclear. We hence aimed to evaluate peri-transplant outcomes and implications of TIPS in liver transplant (LT) candidates.

Methods

We conducted a retrospective cohort study of adult LT candidates listed in the United Network for Organ Sharing (UNOS) database from January 1, 2000 to January 3, 2025. Waitlist outcomes include development of portal hypertension-related complications, time-to-transplant and waitlist survival. Post-transplant outcomes include graft survival and overall post-transplant survival. These outcomes were compared between patients with and without TIPS, and across disease etiologies among TIPS recipients.

Results

Among 169,681 waitlist registrants (19,940 with TIPS, 149,741 without TIPS), TIPS was associated with higher odds of portal vein thrombosis during waitlist (OR: 1.365, 95% CI: 1.270 to 1.467, p < 0.001) and lower odds of ascites during waitlist (OR: 0.874, 95% CI: 0.818 to 0.934, p < 0.001). TIPS recipients had significantly higher 90-day and 1-year time-to-transplant and waitlist survival, with minimal differences in graft survival and overall post-transplant survival. Among TIPS recipients, patients with alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease had significantly lower 90-day and 1-year time-to-transplant and higher 1-year waitlist survival compared to patients with hepatitis C.

Conclusion

TIPS is associated with improved waitlist survival and timely transplantation without negatively impacting post-transplant outcomes. These findings support the use of TIPS in a select group of patients with high burden of portal hypertensive complications.