Association Between Transjugular Intrahepatic Shunt (TIPS) and Waitlist Outcomes in Simultaneous Liver Kidney (SLK) Transplant Candidates.

BACKGROUND

The association between transjugular intrahepatic portosystemic shunt TIPS and waitlist outcomes in simultaneous liver-kidney (SLK) transplant recipients remains unclear.

METHODS

Between 2003 and 2023, we examined the scientific registry of transplant recipients. All adult candidates with overlapping waiting lists for liver and kidney transplants (N = 15 087) were analyzed (entire cohort). Candidates without TIPS (n = 13 980) and with (n = 1107) were followed through November 30, 2023, and the following outcomes were analyzed: death, SLK transplant, liver- or kidney-alone transplant, or removal from the list. The Aalen-Johansen method was used to calculate the cumulative incidence rates of the outcomes, where the outcomes were considered competing risks. Mixed effects Cox proportional hazard models were used to compare the outcomes by TIPS status. We separately analyzed dialysis-dependent candidates (n = 10 370).

RESULTS

In the entire cohort, the 1-year cumulative incidence of death in those without TIPS was higher than in those with (12.5% vs. 9%). In the dialysis-dependent cohort, the 1-year death incidence was 13.3% versus 8.8% in those without TIPS and those with, respectively. In the multivariable Cox proportional hazard models, TIPS was associated with a 29% lower mortality risk in the entire cohort (HR = 0.71, 95% CI: 0.60-0.84, p < 0.001) and a 33% lower risk of mortality in the dialysis-dependent cohort. The likelihood of receiving SLK was lower for recipients with TIPS in the univariable analysis. However, this association was attenuated after adjustment. The causes of removal were similar irrespective of TIPS status in both cohorts.

CONCLUSION

In this large cohort of SLK candidates, those with TIPS had a better waitlist survival, irrespective of their dialysis requirements before transplantation. Prospective studies are needed to validate these findings.