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

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

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.

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular* / complications
  • Carcinoma, Hepatocellular* / mortality
  • Carcinoma, Hepatocellular* / surgery
  • Female
  • Humans
  • Hypertension, Portal / complications
  • Hypertension, Portal / surgery
  • Liver Neoplasms* / complications
  • Liver Neoplasms* / mortality
  • Liver Neoplasms* / surgery
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Portasystemic Shunt, Transjugular Intrahepatic*
  • Propensity Score
  • Registries
  • Retrospective Studies
  • Treatment Outcome
  • Waiting Lists* / mortality
  • alpha-Fetoproteins / analysis
  • alpha-Fetoproteins / metabolism

Substances

  • alpha-Fetoproteins

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The Swiss National Science Foundation (grant number 182471), the “Fondation Francis and Marie-France Minkoff,” the “Fondation de la Recherche Médicale Carlos et Elsie De Reuter,” the “Fondation Gilles Mentha,” the Swiss Society of Gastroenterology (SGG-SSG), the Swiss Society of Visceral Surgery (SGVC-SSCV), and the Leenaards Foundation (grant number 5489) funded this research.