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Post-TIPS Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Real-World Comparative Study.

Ali Emre Bardak1, Hind El Naamani1, Gizem Teker2

  • 1Department of Medicine, Boston Medical Center-Brighton.

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PubMed
Summary

Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) have similar survival and complication rates compared to other etiologies. This supports using current TIPS data for MASLD patients.

Keywords:
MASHMASLDTIPSmetabolic dysfunction-associated steatotic liver diseaseportal hypertension

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Area of Science:

  • Hepatology
  • Interventional Radiology
  • Gastroenterology

Background:

  • Limited data exist on transjugular intrahepatic portosystemic shunt (TIPS) outcomes specifically for metabolic dysfunction-associated steatotic liver disease (MASLD) cirrhosis.
  • Existing TIPS outcome data primarily derive from alcohol- or viral-related cirrhosis.
  • Differences in portal hypertension and cardiometabolic burden in MASLD raise questions about its post-TIPS prognosis.

Purpose of the Study:

  • To compare short-term outcomes of transjugular intrahepatic portosystemic shunt (TIPS) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) cirrhosis versus alcohol- or viral-related cirrhosis.
  • To evaluate survival, transplant-free survival, and complication rates after initial TIPS placement.
  • To assess the applicability of current TIPS evidence to the growing population with MASLD.

Main Methods:

  • Retrospective cohort study using the TriNetX US Collaborative Network.
  • Identified adult patients with cirrhosis who received TIPS after January 1, 2015.
  • Utilized propensity score matching to balance cohorts based on demographics, MELD-Na, hematologic indices, and cirrhosis complications, with sensitivity analyses for cardiometabolic comorbidities.

Main Results:

  • After propensity score matching, 467 patients were in each cohort (MASLD vs. alcohol/viral cirrhosis).
  • One-year overall survival (HR 0.94) and transplant-free survival (HR 1.09) did not significantly differ between groups.
  • Post-TIPS complication rates were comparable, though liver transplantation occurred more frequently in the MASLD cohort (RR 1.89).

Conclusions:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) cirrhosis is not associated with worse short-term survival or post-TIPS complication rates compared to alcohol- or viral-related cirrhosis when baseline disease severity is matched.
  • These findings support the extrapolation of contemporary short-term transjugular intrahepatic portosystemic shunt (TIPS) outcome data to patients with MASLD.
  • Further research may explore long-term outcomes and specific management strategies for MASLD patients undergoing TIPS.