Skeletal Muscle Mass Improvement and Survival After TIPS in Patients With Cirrhosis and Low Skeletal Muscle Index

Aims Sarcopenia worsens prognosis in cirrhosis. We aimed to investigate whether transjugular intrahepatic portosystemic shunt (TIPS) is associated with improvement in skeletal muscle mass, and whether such improvement translates to better survival. Methods Single‐center retrospective cohort study including 285 patients with cirrhosis (between January 2014 and December 2023). Patients were stratified by TIPS and baseline low skeletal muscle index (SMI). Skeletal muscle improvement was defined as a > 10% increase in SMI from baseline. Propensity score matching (age, sex, cirrhosis etiology, and Child‐Pugh class) was performed. Conventional Cox and time‐dependent Cox regression (to address immortal time bias) were used. Primary endpoints were the skeletal muscle mass improvement and transplant‐free survival. Results Of 285 patients, 81 had low baseline SMI. TIPS was independently associated with higher likelihood of skeletal muscle improvement (adjusted hazard ratio [HR] 6.20, 95% confidence interval [CI] 1.78–21.56, p = 0.004). SMI and subcutaneous adipose tissue index increased significantly after TIPS. In conventional Cox analysis, muscle improvement was associated with better transplant‐free survival; however, this association lost statistical significance in the time‐dependent Cox model (adjusted HR 0.70, 95% CI 0.24–2.04, p = 0.517). Conclusion TIPS is associated with skeletal muscle and subcutaneous fat mass gain in patients with cirrhosis and low SMI. A survival benefit from muscle improvement could not be confirmed after accounting for immortal time bias. Limitations include single‐center retrospective design, the use of computed tomography‐derived SMI alone to define low muscle mass, without functional tests for sarcopenia, and limited event numbers. Further prospective studies are warranted.