Impact of Transjugular Intrahepatic Portosystemic Shunt on Waitlist and Post-transplant Outcomes in Liver Transplant Candidates

Ryan Yanzhe Lim; Peter Jin Sun Low; Wen Hui Lim; Asvin Selvakumar; Do Han Kim; Nicole Shu Ying Tang; Pojsakorn Danpanichkul; Ethan Kai Jun Tham; Hirokazu Takahashi; Masahide Fujiyoshi; Bryant Low; Vincent L Chen; Karn Wijarnpreecha; Meena Bansal; Daniel Q Huang; Mazen Noureddin; Mark Muthiah; Mohammad Shadab Siddiqui; Eunice Xiang-Xuan Tan; Margaret Lp Teng

doi:10.1007/s10620-026-09825-6

Impact of Transjugular Intrahepatic Portosystemic Shunt on Waitlist and Post-transplant Outcomes in Liver Transplant Candidates

Dig Dis Sci. 2026 Apr 4. doi: 10.1007/s10620-026-09825-6. Online ahead of print.

Authors

Ryan Yanzhe Lim^#¹, Peter Jin Sun Low^#¹, Wen Hui Lim², Asvin Selvakumar², Do Han Kim³, Nicole Shu Ying Tang¹, Pojsakorn Danpanichkul⁴, Ethan Kai Jun Tham¹, Hirokazu Takahashi⁵, Masahide Fujiyoshi⁶, Bryant Low¹, Vincent L Chen⁷, Karn Wijarnpreecha⁸, Meena Bansal^{9

10

11}, Daniel Q Huang^{1

12

13}, Mazen Noureddin¹⁴, Mark Muthiah^{1

12

13}, Mohammad Shadab Siddiqui¹⁵, Eunice Xiang-Xuan Tan^#^{1

12

13}, Margaret Lp Teng^#^{16

17

18}

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
² Department of Medicine, National University Hospital, Singapore, Singapore.
³ Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁴ Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
⁵ Faculty of Medicine, Division of Metabolism and Endocrinology, Saga University, Saga, Japan.
⁶ Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
⁸ Division of Gastroenterology and Hepatology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.
⁹ The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁰ Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹¹ Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹² Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
¹³ National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.
¹⁴ Houston Methodist Hospital and Houston Research Institute, Houston, TX, USA.
¹⁵ Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, VA, USA.
¹⁶ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. margaret_teng@nus.edu.sg.
¹⁷ Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore. margaret_teng@nus.edu.sg.
¹⁸ Division of Gastroenterology, Department of Medicine, Alexandra Hospital, Singapore, Singapore. margaret_teng@nus.edu.sg.

^# Contributed equally.

PMID: 41934580
DOI: 10.1007/s10620-026-09825-6

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is utilized to manage portal hypertensive complications in patients with decompensated cirrhosis. However, its effects on transplant candidacy and peri-operative outcomes remain unclear. We hence aimed to evaluate peri-transplant outcomes and implications of TIPS in liver transplant (LT) candidates.

Methods: We conducted a retrospective cohort study of adult LT candidates listed in the United Network for Organ Sharing (UNOS) database from January 1, 2000 to January 3, 2025. Waitlist outcomes include development of portal hypertension-related complications, time-to-transplant and waitlist survival. Post-transplant outcomes include graft survival and overall post-transplant survival. These outcomes were compared between patients with and without TIPS, and across disease etiologies among TIPS recipients.

Results: Among 169,681 waitlist registrants (19,940 with TIPS, 149,741 without TIPS), TIPS was associated with higher odds of portal vein thrombosis during waitlist (OR: 1.365, 95% CI: 1.270 to 1.467, p < 0.001) and lower odds of ascites during waitlist (OR: 0.874, 95% CI: 0.818 to 0.934, p < 0.001). TIPS recipients had significantly higher 90-day and 1-year time-to-transplant and waitlist survival, with minimal differences in graft survival and overall post-transplant survival. Among TIPS recipients, patients with alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease had significantly lower 90-day and 1-year time-to-transplant and higher 1-year waitlist survival compared to patients with hepatitis C.

Conclusion: TIPS is associated with improved waitlist survival and timely transplantation without negatively impacting post-transplant outcomes. These findings support the use of TIPS in a select group of patients with high burden of portal hypertensive complications.

Keywords: Liver transplantation; Transjugular intrahepatic portosystemic shunt.