Schmidt Kathryn, Meier Tristan, Cole Kristin, Olson Jody C, Taner Timucin, Riad Samy, Simonetto Douglas A
Division of Hepatology, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA.
Mayo School of Medicine, Rochester, Minnesota, USA.
Clin Transplant. 2025 Aug;39(8):e70279. doi: 10.1111/ctr.70279.
The association between transjugular intrahepatic portosystemic shunt TIPS and waitlist outcomes in simultaneous liver-kidney (SLK) transplant recipients remains unclear.
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).
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.
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.
经颈静脉肝内门体分流术（TIPS）与肝肾联合移植（SLK）受者等待名单上的结局之间的关联仍不明确。
在2003年至2023年期间，我们查阅了移植受者科学登记处的数据。对所有同时列入肝脏和肾脏移植等待名单的成年候选人（N = 15087）进行了分析（整个队列）。对未接受TIPS的候选人（n = 13980）和接受TIPS的候选人（n = 1107）进行随访，直至2023年11月30日，并分析以下结局：死亡、肝肾联合移植、单独肝脏或肾脏移植，或从等待名单中移除。采用Aalen-Johansen方法计算结局的累积发病率，其中结局被视为竞争风险。使用混合效应Cox比例风险模型按TIPS状态比较结局。我们分别分析了依赖透析的候选人（n = 10370）。
在整个队列中，未接受TIPS者的1年累积死亡率高于接受TIPS者（12.5%对9%）。在依赖透析的队列中，未接受TIPS者和接受TIPS者的1年死亡率分别为13.3%和8.8%。在多变量Cox比例风险模型中，TIPS与整个队列中29%的较低死亡风险相关（HR = 0.71，95%CI：0.60 - 0.84，p < 0.001），在依赖透析的队列中死亡风险降低33%。在单变量分析中，接受TIPS的受者接受肝肾联合移植的可能性较低。然而，调整后这种关联减弱。两个队列中，无论TIPS状态如何，移除的原因相似。
在这个大型的肝肾联合移植候选人群体中，接受TIPS的患者在等待名单上的生存率更高，无论其移植前的透析需求如何。需要进行前瞻性研究来验证这些发现。
