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

Post-transjugular intrahepatic portosystemic shunt (TIPS) outcome data are derived largely from alcohol- or viral-related cirrhosis; etiology-specific evidence in metabolic dysfunction-associated steatotic liver disease (MASLD) remains limited. Given differences in portal hypertension physiology and cardiometabolic burden, whether post-TIPS outcomes in MASLD mirror other etiologies is uncertain.

Using the TriNetX US Collaborative Network, we identified adults with cirrhosis who underwent initial TIPS placement on or after January 1, 2015, and categorized them as MASLD versus alcohol- or viral-related cirrhosis. Propensity Score Matching was performed to balance the demographics, liver disease severity (MELD-Na components), hematologic indices, and cirrhosis-related complications. Complementary analyses were performed to incorporate cardiometabolic comorbidities. The primary outcomes were 1-year overall survival and transplant-free survival. Secondary outcomes included liver transplantation, TIPS revision, variceal bleeding, paracentesis, hepatic encephalopathy, hepatorenal syndrome, and initiation of dialysis.

After matching, 467 patients remained in each cohort (median follow-up, 365 d). One-year overall survival did not differ between MASLD and alcohol- or viral-related cirrhosis (HR 0.94, 95% CI: 0.70-1.24; P=0.64), nor did transplant-free survival (HR 1.09, 95% CI: 0.85-1.41; P=0.50). Most post-TIPS complications were comparable. Liver transplantation occurred more frequently in the MASLD cohort (RR 1.89, 95% CI: 1.08-3.30; P=0.02). The findings were consistent after additional matching for cardiometabolic comorbidities.

When baseline disease severity is comparable, MASLD-related cirrhosis is not associated with worse short-term survival or post-TIPS complication rates compared with alcohol- or viral-related cirrhosis, supporting the extrapolation of contemporary short-term TIPS outcome data to MASLD.