Alcohol Use After TIPS Implantation Significantly Increases the Risk of ACLF and Liver-Related Death

Complications related to portal hypertension (PH) in patients with alcohol-related liver disease (ALD) can be controlled by transjugular intrahepatic portosystemic shunt (TIPS) placement; however, the impact of ongoing alcohol use (AU) after TIPS remains scarcely investigated.

ALD patients undergoing TIPS implantation between 2000 and 2022 were included. Laboratory/demographic parameters and clinical events/outcomes were compared per post-TIPS AU status and to a group of n = 55 decompensated ALD patients with ongoing AU who did not receive TIPS.

Overall, 248 TIPS patients (78.2% male; median age: 55.5 years; ascites: 69.8%; median MELD: 12), including 90 (36.3%) with ongoing AU after TIPS were included. AU post-TIPS was independently associated with ACLF (asHR 2.27; 95% CI 1.40-3.66; p < 0.001) and liver-related death (asHR 1.68; 95% CI 1.05-2.67; p = 0.030) among patients undergoing TIPS in adjusted multivariable competing risks analysis. When comparing matched decompensated AU patients treated versus non-treated by TIPS, multivariable competing risks regression revealed MELD (asHR 1.07; 95% CI 1.01-1.13; p = 0.033) but not TIPS use (asHR 0.70; 95% CI 0.45-1.10; p = 0.120) as independent risk factors for ACLF, despite TIPS patients having higher levels of systemic inflammation (CRP).

Post-TIPS AU was frequent and an independent risk factor for ACLF and liver-related death, underlining the importance of interdisciplinary measures supporting alcohol abstinence. TIPS should still not be withheld from ALD patients developing PH complications, since it does not predispose them to ACLF and may prevent liver-related death.