S2718 Outcomes of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Patients With Hepatorenal Syndrome: A Meta-Analysis

Introduction: Hepatorenal syndrome (HRS) is a life-threatening complication of decompensated cirrhosis with ascites arising from an inadequate response to circulatory and hemodynamic changes, compounded by systemic inflammation and bacterial translocation. Transjugular intrahepatic portosystemic shunt (TIPS) has been used as a salvage therapy for diuretic intractable/refractory ascites but the data on outcomes in patients with renal dysfunction remains variable. Methods: We performed a systematic literature search of English-language articles in PubMed and Embase from inception to May 2025, aiming to assess short-term and long-term mortality and renal function recovery in patients with HRS after TIPS. The pooled proportion and mean difference were calculated by using a random-effect model with 95% confidence interval (CI). Outcomes were assessed with arcsine square root transformation to account for variance stabilization. Heterogeneity was assessed by the Cochrane Q test and the I² statistics. Results: Fourteen publications with 2,789 patients were included. The pooled short-term (<90 days) and 1-year survival rates after TIPS were 78% (95% CI: 77 to 80%, I² = 0%) and 67% (95% CI: 63 to 70%, I² = 0%), respectively. Renal function improvement was seen in 64.4% (95% CI: 62.1 to 66.6%, I² = 0) in patients after TIPS. Renal functions significantly improved after the TIPS [serum creatinine (sCr): 0.93 ± 0.24 mg/dl vs pre-TIPS 1.42 ± 0.49 mg/dl; P = 0.0002]. The pooled rate of hepatic encephalopathy (HE) after TIPS was 38% (95% CI: 35 to 41%), while liver failure occurred in 3% of patients after TIPS (95% CI: 3 to 4%, I² = 0%). Conclusion: TIPS in patients with HRS is associated with improvement in renal function and moderate reductions in both short- and long-term mortality. While post TIPS liver failure remains a rare occurrence, little more than a third of patients develop HE, which is an improvement from a previous meta-analysis reported value of 49%. This improvement in post-TIPS HE can be attributed to improvement in patient selection in preferential change in practice pattern towards small-caliber (8 mm) TIPS shunt. Future studies aimed towards defining the optimal portosystemic gradient reduction are required to further decreased the incidence of post TIPS-HE.