Alcohol Use After TIPS Implantation Significantly Increases the Risk of ACLF and Liver‐Related Death

作者：Caroline Schwarz, Andrea Kornfehl, Reema Abid, Theresa Bucsics, Julia Kappel, Michael Schwarz, Benedikt Hofer, Nina Dominik, Georg Kramer, Benedikt Simbrunner, Mathias Jachs, Lukas Reider, M Trauner, Mattias Mandorfer, Thomas Reiberger, Lukas Hartl · 发表于：United European Gastroenterology Journal · 年份：2025 · DOI：10.1002/ueg2.70131 · 被引用次数：3 · 研究领域：Alcohol Consumption and Health Effects、Alcoholism and Thiamine Deficiency、Liver Disease and Transplantation

BACKGROUND: Complications related to portal hypertension (PH) in patients with alcohol-related liver disease (ALD) can be controlled by transjugular intrahepatic portosystemic shunt (TIPS) placement; however, the impact of ongoing alcohol use (AU) after TIPS remains scarcely investigated. METHODS: ALD patients undergoing TIPS implantation between 2000 and 2022 were included. Laboratory/demographic parameters and clinical events/outcomes were compared per post-TIPS AU status and to a group of n = 55 decompensated ALD patients with ongoing AU who did not receive TIPS. RESULTS: Overall, 248 TIPS patients (78.2% male; median age: 55.5 years; ascites: 69.8%; median MELD: 12), including 90 (36.3%) with ongoing AU after TIPS were included. AU post-TIPS was independently associated with ACLF (asHR 2.27; 95% CI 1.40-3.66; p < 0.001) and liver-related death (asHR 1.68; 95% CI 1.05-2.67; p = 0.030) among patients undergoing TIPS in adjusted multivariable competing risks analysis. When comparing matched decompensated AU patients treated versus non-treated by TIPS, multivariable competing risks regression revealed MELD (asHR 1.07; 95% CI 1.01-1.13; p = 0.033) but not TIPS use (asHR 0.70; 95% CI 0.45-1.10; p = 0.120) as independent risk factors for ACLF, despite TIPS patients having higher levels of systemic inflammation (CRP). CONCLUSION: Post-TIPS AU was frequent and an independent risk factor for ACLF and liver-related death, underlining the importance of interdisciplinary measures supp...