TOPLINE

Among patients with acute-on-chronic liver failure (ACLF) with fluid overload, transjugular intrahepatic portosystemic shunt (TIPS) insertion was associated with a reduction in the risk for short-term mortality; a resolution of ACLF was noted in more than 60% of those who received TIPS.

METHODOLOGY

• Researchers conducted a retrospective case-control study using data from two prospective cohorts to assess whether TIPS provides survival benefits or can serve as an effective bridging therapy in patients with ACLF with fluid overload.
• ACLF was defined and diagnosed according to a specific criterion and graded as ACLF-1, comprising patients with single kidney organ failure (ACLF-1a) or non-renal organ failure plus kidney dysfunction (creatinine levels between 1.5 and 1.9 mg/dL) and/or brain dysfunction (encephalopathy grade 1 or 2 according to the West Haven criteria; ACLF-1b); ACLF-2, comprising patients with two organ failures; and ACLF-3, comprising patients with three or more organ failures.
• A total of 118 adult patients with ACLF were included, of whom 59 from the German TIPS-Registry study who received TIPS (median age, 63 years; 25.4% women) were matched 1:1 with 59 from the CANONIC study who did not receive TIPS (median age, 63 years; 27.1% women) using propensity score matching.
• Data on mortality and liver transplantation were considered for analysis.

TAKEAWAY

• Hepatorenal syndrome was the main indication for TIPS insertion, which was noted in 61.0% of patients. TIPS insertion in patients with ACLF was associated with a 78% reduction in the risk for mortality at 28 days (hazard ratio [HR], 0.22; P = .018).
• In patients with ACLF who received TIPS, high-grade hepatic encephalopathy (ie, brain organ failure) no longer occurred (0.0% vs 10.2%; P = .027). At discharge, TIPS insertion was linked to reductions in the frequency of hepatic encephalopathy (P = .012) and model for end-stage liver disease scores (P < .0001) from baseline.
• ACLF resolution occurred in 61.0% of patients who received TIPS. The survival benefit after 90 days was no longer observed following the TIPS procedure.
• Coagulation organ failure (subdistribution HR, 9.94; P = .006), circulatory organ failure (subdistribution HR, 4.77; P = .022), and bilirubin levels (subdistribution HR, 1.07; P = .004) were associated with a higher risk for mortality at 28 days.

IN PRACTICE

"TIPS-insertion should be regarded as a bridging tool for early transplantation," the authors wrote.

"A careful selection of those who may be candidates for the procedure is emphasized; nevertheless, their short-term outcome can be notably improved, thus allowing for the planning of a subsequent definitive therapy, such as bridging to transplant," they added.

SOURCE

This study was led by Eduardo Cervantes-Alvarez, MD, PhD, Department of Internal Medicine B, University Hospital Münster, Münster, Germany. It was published online on July 06, 2026, in Clinical and Translational Gastroenterology.

LIMITATIONS

The study had a small sample size due to the focus only on patients with fluid overload and the exclusion of some patients for the lack of data. Outcome comparisons between the two cohorts may have lacked precision due to different follow-up timelines.

DISCLOSURES

The authors received support through grants from the Deutsche Forschungsgemeinschaft and Cellex Foundation and declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.