Liver and Bile

Hepatology. 2025;81(4):1244-1255

Nobel YR, Boike JR, Mazumder NR, Thornburg B, Hoffman R, Kolli KP, Fallon M, Lai JC, Morelli G, Spengler EK, Said A, Desai AP, Paul S, Goel A, Hu K, Frenette C, Gregory D, Padilla C, Zhang Y, VanWagner LB, Verna EC; Advancing Liver Therapeutic Approaches (ALTA) Study Group

Predictors of long-term clinical outcomes after TIPS: An ALTA group study

Background and aims: While transjugular intrahepatic portosystemic shunt (TIPS) is traditionally considered a bridge to liver transplant (LT), some patients achieve long-term transplant-free survival (TFS) with TIPS alone. Prognosis and need for LT should not only be assessed at time of procedure, but also re-evaluated in patients with favorable early outcomes.
Approach and results: Adult recipients of TIPS in the multicenter advancing liver therapeutic approaches retrospective cohort study were included (n = 1127 patients; 2040 person-years follow-up). Adjusted competing risk regressions were used to assess factors associated with long-term post-TIPS clinical outcomes at the time of procedure and 6 months post-TIPS. Model for End-Stage Liver Disease-Sodium (MELD-Na) at TIPS was significantly associated with post-TIPS mortality (subdistribution hazards ratio [HR] of death 1.1 [p = 0.42], 1.3 [p = 0.04], and 1.7 [p < 0.01] for MELD-Na 15–19, 20–24, and ≥ 25 relative to MELD-Na < 15, respectively). MELD 3.0 was also associated with post-TIPS outcomes. Among the 694 patients (62%) who achieved early (6 months) post-TIPS TFS, rates of long-term TFS were 88% at 1 year and 57% at 3 years post-TIPS. Additionally, a within-individual increase in MELD-Na score of > 3 points from TIPS to 6 months post-TIPS was significantly associated with long-term mortality, regardless of initial MELD-Na score (subdistribution HR of death 1.8, p < 0.01). For patients with long-term post-TIPS TFS, rates of complications of the TIPS or portal hypertension were low.

Conclusions: Among patients with early post-TIPS transplant-free survival (TFS), prognosis and need for liver transplant should be reassessed, informed by post-procedure changes in MELD-Na and clinical status. For selected patients, “destination TIPS” without liver transplant may offer long-term survival with freedom from portal hypertensive complications.

DOI:  10.1097/hep.0000000000001091