*Purpose: Since the effect of transjugular intrahepatic portosystemic shunt (TIPS) on post LT outcomes is not well understood, we undertook this analysis of a large national transplant registry to assess outcomes in LT recipients with NASH who had undergone pre-LT TIPS.

*Methods: UNOS-STAR registry (2005-2019) was used to identify adult deceased donor LT recipients with diagnosis of nonalcoholic steatohepatitis (NASH/cryptogenic cirrhosis). We compared the following endpoints: all-cause mortality, graft failure, and organ-specific causes of death in those with and without pre-LT TIPS placement. Living/multiorgan transplants were excluded.

*Results: From 14575 LT recipients with NASH, 1700 underwent preoperative TIPS insertion and 12875 did not receive TIPS. The median follow-up period was 3.07 years. Those who underwent TIPS were older, more likely to be male, and more likely to be White or Hispanic. Those who received pre-LT TIPS had higher incidence of hepatic encephalopathy, and lower median MELD scores (22.3 vs 24.2 p<0.001). In the iterative cox regression analysis, preoperative TIPS insertion was associated with higher all-cause mortality (aHR 1.15 95%CI 1.03-1.27), as well as deaths due to general cardiac causes (aHR 1.44 95%CI 1.16-1.80), cardiac arrhythmia (aHR 4.15 95%CI 1.93-8.94), and congestive heart failure (aHR 2.18 95%CI 1.15-4.15). This increase in mortality persisted despite adjusting for recipient demographics, comorbidities, medications, biochemical parameters, and donor information.

*Conclusions: Our analysis of a large national transplant database demonstrates the deleterious effect of pre-LT TIPS on post-LT outcomes in recipients with NASH, attributable to increased all-cause mortality and cardiac events. It is therefore important that careful pre-TIPS cardiac screening and evaluation be undertaken to mitigate these risks prior to LT, particularly in those with NASH.

« Back to 2022 American Transplant Congress