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

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.