Global 
Deutschland Liver and Bile
HEP Rep. 2026;8(2):101699
Outcomes after TIPS in patients with cirrhosis and sarcopenia: A systematic review and meta-analysis
Background and aims: Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension (variceal bleeding and refractory ascites). Sarcopenia affects 40–70% of patients with cirrhosis. The study evaluated the improvement in sarcopenia after TIPS, the proportion of patients developing overt hepatic encephalopathy (HE) after TIPS and its association with sarcopenia, and the association between sarcopenia and mortality after TIPS.
Methods: The researchers conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies included adults with cirrhosis and sarcopenia assessed by computed tomography (CT), using the skeletal muscle index (L3-SMI), or psoas muscle index (L3-PMI). The authors searched in eight databases for randomized trials, cohort studies, and case-control, cross-sectional, and case series studies.
Results: Twenty studies were included. The pooled prevalence of sarcopenia in patients with cirrhosis undergoing TIPS was 55.4% (95% CI: 41.7–68.2%). Among these, sarcopenia improved in 57% of patients (95% CI: 48–65%) after TIPS, with a mean L3-SMI increase of 4.53 cm2/m2 (range, 2.4–6.9 cm2/m2). Sarcopenia was associated with higher odds of overt HE (pooled odds ration [OR] = 3.40; 95% CI: 1.85–6.25, p < 0.001) and a higher proportion of overt HE (43%; 95% CI: 26–61%) than in patients without sarcopenia (12%; 95% CI: 7–20%). The proportionate mortality after TIPS was 18.3% (95% CI: 14.6–22.8%), across 6–33.6 months of follow-up. The association between sarcopenia and mortality was not significant (HR = 1.95; 95% CI: 0.89–4.31; p = 0.078).
Conclusions: In patients with cirrhosis and sarcopenia, TIPS is often followed by an improvement in sarcopenia. Sarcopenia is associated with higher odds of overt HE, whereas the effect of sarcopenia on mortality after TIPS remains uncertain.