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

Hepatology. 2025 Apr 1;81(4):1244-1255. doi: 10.1097/HEP.0000000000001091. Epub 2024 Sep 10.

Abstract

Background and aims: While 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. MELD-Na at TIPS was significantly associated with post-TIPS mortality (subdistribution hazards ratio 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 (62%) patients who achieved early (6 mo) 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 hazards ratio 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 TFS, prognosis and need for LT should be reassessed, informed by postprocedure changes in MELD-Na and clinical status. For selected patients, "destination TIPS" without LT may offer long-term survival with freedom from portal hypertensive complications.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • End Stage Liver Disease* / mortality
  • End Stage Liver Disease* / surgery
  • Female
  • Humans
  • Hypertension, Portal
  • Liver Transplantation* / statistics & numerical data
  • Male
  • Middle Aged
  • Portasystemic Shunt, Transjugular Intrahepatic* / adverse effects
  • Portasystemic Shunt, Transjugular Intrahepatic* / mortality
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome