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. 2024 Jun 26:37:12781.
doi: 10.3389/ti.2024.12781. eCollection 2024.

Transjugular Intrahepatic Portosystemic Shunt Is Associated With Better Waitlist Management of Liver Transplant Candidates With Hepatocellular Carcinoma

Sofia El Hajji  1   2 , Stéphanie Lacotte  1   2 , Beat Moeckli  1   2 , François Cauchy  1 , Philippe Compagnon  1   3 , Christian Toso  1   2   3
Affiliations

Transjugular Intrahepatic Portosystemic Shunt Is Associated With Better Waitlist Management of Liver Transplant Candidates With Hepatocellular Carcinoma

Sofia El Hajji et al. Transpl Int. .

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) reduces portal hypertension complications. Its impact on hepatocellular carcinoma (HCC) remains unclear. We evaluated 42,843 liver transplant candidates with HCC from the Scientific Registry of Transplant Recipients (2002-2022). 4,484 patients with and without TIPS were propensity score-matched 1:3. Analysing wait-list changes in total tumor volume, HCC count, and alpha-fetoprotein levels, and assessing survival from listing and transplantation; TIPS correlated with a decreased nodule count (-0.24 vs. 0.04, p = 0.028) over a median wait period of 284 days (IQR 195-493) and better overall survival from listing (95.6% vs. 91.5% at 1 year, p < 0.0001). It was not associated with changes in tumor volume (0.28 vs. 0.11 cm³/month, p = 0.58) and AFP (14.37 vs. 20.67 ng/mL, p = 0.42). Post-transplant survival rates (91.8% vs. 91.7% at 1 year, p = 0.25) and HCC recurrence (5.1% vs. 5.9% at 5 years, p = 0.14) were similar, with a median follow-up of 4.98 years (IQR 2.5-8.08). While TIPS was associated with a reduced nodule count and improved waitlist survival, it did not significantly impact HCC growth or aggressiveness. These findings suggest potential benefits of TIPS in HCC management, but further studies need to confirm TIPS safety.

Keywords: hepatocellular carcinoma; liver transplantation; progression; recurrence; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

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FIGURE 1
FIGURE 1
Overall survival from listing in the matched cohort, censoring transplanted patients and comparing patients with and without TIPS.
FIGURE 2
FIGURE 2
Overall survival from transplantation in the matched cohort comparing patient with and without TIPS.
FIGURE 3
FIGURE 3
Competed cumulative risk incidence of HCC recurrence comparing patients with and without TIPS. Gray’s test p = 0.14.
See this image and copyright information in PMC

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