Post-TIPS Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease

BACKGROUND: Post-transjugular intrahepatic portosystemic shunt (TIPS) outcome data are derived largely from alcohol- or viral-related cirrhosis; etiology-specific evidence in metabolic dysfunction-associated steatotic liver disease (MASLD) remains limited. Given differences in portal hypertension physiology and cardiometabolic burden, whether post-TIPS outcomes in MASLD mirror other etiologies is uncertain. METHODS: Using the TriNetX US Collaborative Network, we identified adults with cirrhosis who underwent initial TIPS placement on or after January 1, 2015, and categorized them as MASLD versus alcohol- or viral-related cirrhosis. Propensity Score Matching was performed to balance the demographics, liver disease severity (MELD-Na components), hematologic indices, and cirrhosis-related complications. Complementary analyses were performed to incorporate cardiometabolic comorbidities. The primary outcomes were 1-year overall survival and transplant-free survival. Secondary outcomes included liver transplantation, TIPS revision, variceal bleeding, paracentesis, hepatic encephalopathy, hepatorenal syndrome, and initiation of dialysis. RESULTS: After matching, 467 patients remained in each cohort (median follow-up, 365 d). One-year overall survival did not differ between MASLD and alcohol- or viral-related cirrhosis (HR 0.94, 95% CI: 0.70-1.24; P=0.64), nor did transplant-free survival (HR 1.09, 95% CI: 0.85-1.41; P=0.50). Most post-TIPS complications were comparable. Liver transplantation occurred more frequently in the MASLD cohort (RR 1.89, 95% CI: 1.08-3.30; P=0.02). The findings were consistent after additional matching for cardiometabolic comorbidities. CONCLUSION: When baseline disease severity is comparable, MASLD-related cirrhosis is not associated with worse short-term survival or post-TIPS complication rates compared with alcohol- or viral-related cirrhosis, supporting the extrapolation of contemporary short-term TIPS outcome data to MASLD.