To evaluate the prognostic differences and influencing factors of transjugular intrahepatic portosystemic shunt (TIPS) in decompensated cirrhosis caused by autoimmune liver disease (AILD) versus hepatitis B virus (HBV).

A retrospective analysis was conducted on 470 patients who received TIPS treatment at the First Affiliated Hospital of Nanjing Medical University from January 2018 to June 2023. Patients were divided into the AILD group (n=47) and the HBV group (n=102). Baseline data, preoperative and postoperative portal pressure, surgical conditions, postoperative upper gastrointestinal rebleeding, stent dysfunction, hepatic encephalopathy, and survival prognosis were collected and analyzed.

The median follow-up time was 614 days for the AILD group and 854 days for the HBV group. The 3-month, 6-month, and 1-year mortality rates in the AILD group were 6.38%, 21.27%, and 21.27%, respectively, compared to 2.94%, 3.92%, and 7.84% in the HBV group. The survival rate in the AILD group was significantly lower than that in the HBV group (P=0.029). Univariate and multivariate analyses identified etiology (HR=2.211, 95% CI: 1.111~4.401, P=0.024) and MELD score (HR=1.009, 95% CI: 1.021~1.184, P=0.012) as risk factors for mortality. No significant differences were found between the two groups in terms of rebleeding and hepatic encephalopathy rates, but stent dysfunction was more common in the AILD group (P=0.056). Serum creatinine level was an independent risk factor for overt hepatic encephalopathy (HR=1.004, 95% CI: 1.000~1.007, P=0.038).

TIPS can effectively reduce portal pressure and improve clinical symptoms in patients with decompensated cirrhosis caused by both AILD and HBV. However, AILD patients have a shorter survival period compared to HBV patients, although there are no significant differences in postoperative rebleeding and overt hepatic encephalopathy between the two groups.