Editor's Note: The Advancing Liver Therapeutic Approaches (ALTA) research group is an international organization dedicated to advancing new methods of liver disease treatment. Its members are from leading medical institutions and research centers worldwide. Recently, the group conducted a multicenter retrospective cohort study revealing that the MELD-Na score at the time of transjugular intrahepatic portosystemic shunt (TIPS) surgery is significantly associated with post-operative mortality. Additionally, increases in MELD-Na scores within six months after TIPS surgery are closely linked to patients' long-term outcomes. The study, published online in Hepatology, provides a new perspective on assessing clinical outcomes and the need for liver transplantation following TIPS surgery.Traditionally, TIPS has been regarded as a bridge to liver transplantation (LT). However, recent findings suggest that some patients achieve long-term transplant-free survival (TFS) with TIPS alone. Therefore, clinicians should evaluate patients’ prognosis and the need for liver transplantation before TIPS surgery, particularly for those with favorable early outcomes.
The study included 1,127 adult patients who underwent TIPS surgery, with a follow-up of up to 2,040 person-years. Using adjusted competing risk regression analysis, the research team assessed factors related to long-term clinical outcomes after TIPS, including those measured at the time of surgery and six months post-surgery.
The results showed that the MELD-Na score at the time of TIPS surgery was significantly associated with post-operative mortality. Compared to patients with a MELD-Na score <15, those with MELD-Na scores of 15-19, 20-24, and ≥25 had 10% (P=0.42), 30% (P=0.04), and 70% (P<0.01) higher risks of death, respectively. Additionally, the MELD 3.0 score was also associated with post-TIPS outcomes.
Among the 62% (694 patients) who achieved TFS at six months post-surgery, the long-term TFS rates were 88% at one year and 57% at three years. Notably, an increase in the MELD-Na score by more than three points from the time of TIPS surgery to six months post-surgery was significantly associated with long-term mortality, regardless of the initial MELD-Na score (80% higher risk of death, P<0.01).
The study also found that patients with long-term TFS had lower rates of TIPS-related complications or portal hypertension.
Researcher's Commentary
The study's corresponding author, Dr. Elizabeth C. Verna of the Liver Transplantation Center at Columbia University Irving Medical Center, USA, highlighted that this research offers important guidance for the long-term management of patients following TIPS surgery. It emphasizes the necessity of dynamically adjusting treatment strategies based on individual patient circumstances. This understanding can help optimize the use of TIPS. For patients with early post-TIPS TFS, prognosis and the need for liver transplantation should be reassessed based on changes in MELD-Na scores and clinical status. For some patients, TIPS may serve as "targeted therapy," allowing them to achieve long-term survival without the need for liver transplantation and sparing them from complications related to portal hypertension.
