Impact of transjugular intrahepatic portosystemic shunt on hepatocellular carcinoma: A prospective cohort of liver transplant candidates analysis

Transjugular intrahepatic portosystemic shunt (TIPS) is used to mitigate the side effects of portal hypertension. Its impact on hepatocellular carcinoma (HCC) remains unclear. We conducted an analysis of 43,734 liver transplant candidates with HCC from the prospective Scientific Registry of Transplant Recipients (SRTR) database between 1985-2022. A total 7,404 patients with and without TIPS were propensity score matched 1:3. We assessed wait-list changes in total tumor volume, number of HCC , and alpha-fetoprotein levels. We examined survival rates from time of listing and post-transplantation, as well as the incidence of HCC recurrence post-transplantation. Before matching, patients with TIPS exhibited poorer liver function and less advanced HCCs compared to patients without TIPS. After matching, TIPS was associated with a decrease in the number of HCC nodules (-0.24 vs 0.11, p = 0.008) over a median waiting period of 225 days (IQR 94; 441) and a better overall survival rate from listing (93.0% vs 89.1% at one year, p = 0.0003). TIPS was not associated with altered changes in waitlist tumor volume (0.26 vs -0.07 cm3/month, p = 0.26) and AFP (14.62 vs 12.67 ng/mL, p = 0.79) compared to the non-TIPS group. Both post-transplant survival rates (91.8% vs 91.7% at one year, p = 0.25) and incidence of HCC recurrence (5.2% vs 5.4% at 5 years, p = 0.73) were similar between groups with a median follow-up duration of 5.6 years (IQR 2.7; 9.6). TIPS is associated with improved waitlist survival and a reduction in the number of HCC , potentially due to a better efficacy in HCC treatment. However, TIPS did not have a measurable impact on HCC growth or aggressiveness.

Organizational unit

Transplantation and Hepatology Laboratory

Type

Dataset

DOI

10.26037/yareta:4q74hn6kbjgkji5ktto55cmzz4

Referenced by the following DOI

• 10.3389/ti.2024.12781

License

Creative Commons Attribution-NonCommercial 4.0 International

Keywords

Transjugular intrahepatic portosystemic shunt, Liver transplantation, Recurrence, Survival, Progression, Hepatocellular carcinoma