Impact of Transjugular Intrahepatic Portosystemic Shunt on Hepatocellular Carcinoma: Prospective Cohort of Liver Transplant Candidates’ Analysis

Background Transjugular intrahepatic portosystemic shunt (TIPS) is used to mitigate the side effects of portal hypertension. However, its impact on hepatocellular carcinoma (HCC) remains unclear. Aims We aimed to evaluate its effect on HCC dynamics and patients’ survival. Methods We analysed 43’734 liver transplant candidates diagnosed with HCC from the prospective Scientific Registry of Transplant Recipients database (1985-2022). A total 7’404 patients with and without TIPS were propensity score matched 1:3. We assessed wait-list changes in total tumor volume, HCC count, and alpha-fetoprotein levels. We examined survival rates from time of listing and post-transplantation, as well as the incidence of HCC recurrence post-transplantation. Results Pre-matching, TIPS patients exhibited poorer liver function and less advanced HCCs. Post-matching, TIPS correlated with a decrease in HCC nodules count (-0.24 vs 0.11, p = 0.008) over a median waiting period of 225 days (IQR 94; 441) and better overall survival rate from listing (93.0% vs 89.1% at one year, p = 0.0003). TIPS was not associated with altered changes in waitlist tumor volume (0.26 vs -0.07 cm3/month, p = 0.26) and AFP (14.62 vs 12.67 ng/mL, p = 0.79) compared to the non-TIPS group. Post-transplant survival rates (91.8% vs 91.7% at one year, p = 0.25) and HCC recurrence (5.2% vs 5.4% at 5 years, p = 0.73) were similar, with a median follow-up of 5.6 years (IQR 2.7; 9.6) Conclusion TIPS improved waitlist survival and is associated with decreased HCC nodule count, potentially due to a better efficacy in HCC treatment. However, TIPS did not have a measurable impact on HCC growth or aggressiveness.