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Publications

Journal Article Ppublish

PubMed: 42306237 DOI: 10.1016/j.jceh.2026.103561

Liver Transplant Outcomes in Patients With Transjugular Intrahepatic Portosystemic Shunt: A Retrospective Cohort Study With Propensity Score Analysis.

J Clin Exp Hepatol 16(4):103561

Authors: Marco Biolato, Quirino Lai, Tiziano Galasso, Giuseppe Marrone, Luca Miele, Antonio Liguori, Annamaria Amodeo, Lucia Monastero, Andrea Contegiacomo, Roberto Iezzi, Gabriele Spoletini, Salvatore Agnes, Antonio Grieco, Antonio Gasbarrini, Maurizio Pompili, Alfonso Avolio

Affiliations

  • Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  • Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome, Italy.
  • Department of General and Specialty Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy.
  • General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Italy.
  • Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome, Italy.

Abstract

BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) is used to manage portal hypertension-related complications in patients awaiting liver transplantation. However, the role of pretransplant TIPS placement remains controversial.

METHODS

We conducted a retrospective, single-center cohort study to evaluate the impact of pretransplant TIPS on postoperative complications and in-hospital mortality.

RESULTS

We included 263 cirrhotic patients who underwent liver transplantation from deceased donors between 2015 and 2023. Twenty-three patients (8.7%) underwent pretransplant TIPS placement. All TIPS were placed using controlled-expansion stents, with a median diameter of 8 ± 1 mm. Stent migration was identified intraoperatively in 7 patients (30.4%) and was associated with increased surgical complexity. After propensity score weighting, pretransplant TIPS was not independently associated with operative time, use of venovenous bypass, transfusion requirements, length of intensive care unit (ICU) or hospital stay, comprehensive complication index, major complications (Clavien-Dindo ≥ III), or in-hospital mortality. Conversely, reoperation rates were higher in the TIPS group (17.4% vs. 8.0%, P = 0.003). In multivariable analysis, previous abdominal surgery was the only independent predictor of in-hospital mortality.

CONCLUSIONS

Pretransplant TIPS may allow patients with severe portal hypertension to achieve postoperative outcomes comparable to those without TIPS, but should be reserved for guideline-supported indications, given the lack of demonstrated survival benefit.

MeSH

Hypertension, Liver Transplantation, Stents, Mortality, Cohort Studies, Propensity Score, Hospital Mortality, Liver, Portasystemic Shunt, Surgical, Hypertension, Portal, Transplants, Intensive Care Units, Transplantation, Postoperative Complications, Ascites