S2542 Survival Following Transjugular Intrahepatic Portosystemic Shunt in MASLD and Non-MASLD Cirrhosis: A Retrospective Study From 2000-2023

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease globally, with a growing number of patients progressing to cirrhosis. Transjugular intrahepatic portsytemic shunt (TIPS) is a key intervention for managing complications of portal hypertension in cirrhosis. However, the impact of cirrhosis etiology on post-TIPS survival remains unexplored. Given the distinct cardiometabolic profiles of MASLD patients, understanding the impact of MASLD on survival following TIPS is critical for clinical decision-making. Methods: We conducted a retrospective cohort study of 877 adults with cirrhosis undergoing TIPS at an academic center from 2000 to 2023. Cirrhosis etiology was classified as MASLD or non-MASLD. The primary outcome was overall survival after TIPS placement. Covariates included demographics, comorbidities, medications, decompensating events, indication for TIPS, mean pre- and post-TIPS gradient, stent diameter, post-TIPS complications. Overall survival was assessed using Kaplan-Meier analysis and multivariate Cox regression. Results: Among the 877 patients, the mean (±SD) age was 55 (12). The cohort was predominantly man 542 (62%) and White 831 (94%). 193 (22%) patients had MASLD. MASLD patients were older (61 vs 53 years; OR 1.07, 95% CI 1.06 to 1.09), more frequently woman (56% vs 33%; OR 2.6, 95% CI 1.9 to 3.5), had higher rates of metabolic comorbidities including diabetes mellitus (78% vs 22%; OR 12.7, 95% CI 8.7 to 18.8), hypertension (69% vs 32%; OR 4.8, 95% CI: 3.4 to 6.9), and obesity (76% vs 25%; OR 9.3, 95% CI: 6.5 to 13.7). In adjusted Cox analysis, MASLD was not independently associated with mortality (aHR 0.88, 95% CI: 0.68 to 1.1). Independent predictors of mortality included age (aHR 1.03, 95% CI: 1.02 to 1.04), MELD score (aHR 1.06, 95% CI: 1.05 to 1.08), and Child-Pugh class (C vs A: aHR 2.7, 95% CI: 1.3 to 5.4). Conclusion: Despite a greater burden of cardiometabolic comorbidity, MASLD etiology did not confer worse survival post-TIPS. These findings support the use of TIPS in appropriately selected MASLD patients and suggest that cirrhosis severity, rather than etiology, may drive differences in outcomes. As MASLD prevalence continues to rise globally, these results offer important guidance for TIPS referral.