Oliver Nilsen, Nirbaanjot Walia, Ernest Cheung, Jonathan Abdelmalak, Jessica Spurio, Monique Fernandez, Thomas Freeman, Penelope Hey, Karl Vaz, Marie Sinclair, Avik Majumdar, Adam Testro
TIPS insertion was most often performed for fluid-related indications, with ARLD and MASLD being the common underlying aetiologies. Type 2 diabetes predicted HE, whereas age, MELD and salvage TIPS for variceal haemorrhage were associated with increased mortality.
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) placement remains a key intervention for managing complications of portal hypertension. Regular assessment of patient characteristics and outcomes is required to inform ongoing patient selection.
AIM: To describe the characteristics, indications and outcomes of patients undergoing TIPS and to identify risk factors for post-TIPS hepatic encephalopathy (HE) and mortality.
METHODS: This was a retrospective study of patients who underwent TIPS between 2011 and 2024 at a quaternary liver transplant centre. Demographics, indications for TIPS and outcomes were collected. Multivariable Cox regression analysis was used to identify predictors of 90-day HE and mortality post-TIPS.
RESULTS: In this cohort, TIPS was performed in 143 patients (median age 55 years interquartile range 48-62). Alcohol-related liver disease (ARLD) was the most common aetiology in 57 (40.0%), followed by metabolic dysfunction-associated steatotic liver disease (MASLD) in 26 (18.2%). Indications included ascites and/or hepatic hydrothorax in 76 (53.1%), followed by variceal haemorrhage in 53 (37.1%). Within 90 days, 43.8% developed HE and 18.6% died. Type 2 diabetes mellitus (subdistribution hazard ratio (HR) = 1.99, 95% confidence interval (CI): 1.17-3.38, P = 0.012) was independently associated with HE within 90 days of TIPS, while age (HR = 1.07, 95% CI: 1.02-1.13, P = 0.009), model for end-stage liver disease (MELD) (HR 1.12, 95% CI: 1.05-1.19, P < 0.001) and salvage TIPS for variceal bleeding (HR = 3.77, 95% CI: 1.40-10.15, P = 0.009) were independently associated with 90-day mortality.
CONCLUSION: TIPS insertion was most often performed for fluid-related indications, with ARLD and MASLD being the common underlying aetiologies. Type 2 diabetes predicted HE, whereas age, MELD and salvage TIPS for variceal haemorrhage were associated with increased mortality.