TIPS Beyond Conventional Indications: Encouraging Data in HRS-AKI, but Patient Selection Remains Critical: Scientific Reports | September 2026

What Did the Study Find?

This multicenter Asia-Pacific study evaluated 207 patients undergoing technically successful TIPS across six centres, including high-risk populations with HRS-AKI, CKD and ACLF. s41598-026-70413-9_reference

• Overall transplant-free survival (TFS) was 65.2%.
• TIPS was highly effective for variceal bleeding, preventing rebleeding in 96.3%.
• Complete ascites resolution occurred in only 51%, and persistent ascites was associated with poorer survival. s41598-026-70413-9_reference
• In patients with recent HRS-AKI, TFS was 52.1% and ascites control was 51%.
• Although crude outcomes were worse with HRS-AKI, it was no longer independently associated with death/transplant after adjustment for MELD or FIPS and centre. s41598-026-70413-9_reference
• Outcomes in ACLF were poor, with TFS only 33.3%. s41598-026-70413-9_reference s41598-026-70413-9_reference
• Post-TIPS hepatic encephalopathy occurred in 36.7%; older age, diabetes and previous HE independently increased risk. s41598-026-70413-9_reference

Why Does It Matter?

HRS-AKI has traditionally made clinicians cautious about TIPS. These data suggest that recent HRS-AKI alone may not necessarily preclude TIPS in carefully selected patients when portal-hypertension complications provide an appropriate indication.

GastroAGI Takeaway

The strongest message remains indication-specific: TIPS was excellent for preventing variceal rebleeding but considerably less reliable for eliminating ascites. Importantly, selected patients with HRS-AKI did not show an independent excess mortality risk after adjustment, supporting further evaluation of TIPS in this population. However, the HRS-AKI and especially ACLF analyses were exploratory, retrospective and lacked untreated controls—so these findings should expand investigation and careful selection, not automatically expand TIPS indications.