Association of Cirrhosis Etiology With Outcomes after Transjugular Intrahepatic Portosystemic Shunt: A National...

It is unknown whether outcomes after transjugular intrahepatic portosystemic shunt (TIPS) differ across cirrhosis etiologies, particularly metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to (i) characterize outcomes by cirrhosis etiology at 90 days and 1 year post-TIPS and (ii) identify features associated with post-TIPS outcomes.

Using a national health system database between 2008 and 2023, we identified adults with cirrhosis who underwent TIPS and performed cumulative incidence function and multivariable competing risk analysis by cirrhosis etiology with primary outcome of mortality and competing risk of transplant.

In total, 2846 patients with cirrhosis underwent TIPS (median age 63[interquartile range 56-71], 61% male, 74% non-Hispanic White). Probability of unadjusted transplant-free survival post-TIPS was 84.3% (95% confidence interval [CI] 80.3-88.3) at 90 days and 72.1% (95% CI 67.2-77.0) at 1 year with MASLD, versus alcohol (78.5% [95% CI 76.7-80.3] at 90 days, 68.7% [95% CI 66.7-70.8] at 1 year), viral (78.5% [95% CI 75.6-81.4] at 90 days, 69.1% [95% CI 62.8-75.5] at 1 year), and other etiologies (76.4% [95% CI 73.5-79.4] at 90 days, 62.7% [95% CI 57.7-67.8] at 1 year). In multivariable competing risk regression, MASLD (vs alcohol) was associated with decreased mortality at 90 days (subdistribution hazard ratio 0.59 [95% CI 0.42-0.83]) and 1 year (subdistribution hazard ratio 0.76 [95% CI 0.60, 0.97]) post-TIPS, and similar to viral and other etiologies. Younger age and more recent TIPS were associated with improved survival, whereas pre-TIPS ascites, hepatic encephalopathy, and increasing Charlson Comorbidity Index were associated with increased mortality at 90 days and 1 year post-TIPS.

MASLD cirrhosis has excellent short- and long-term survival post-TIPS. Etiology, age, decompensation profile, and comorbidity meaningfully inform risk and should guide counseling and pre- and post-TIPS care.