TBA (22W102)

Single-centred, retrospective review of Transjugular Intrahepatic Portosystemic Shunt (TIPS) outcomes 2015-2021

Author(s)

Rachel Drayne Julia Sopena-Falco Iqbal Masood Aiden Mc Cormick Ross MacNicholas Mohamed Osman Sara Naimimohasses

Department(s)/Institutions

St Vincent's University Hospital, Hepatology Department

Introduction

TIPS is an effective treatment option for the severe complications of portal hypertension including ascites and variceal bleeds and outcomes have improved since the use of PFTE stents.

Aims/Background

To assess TIPS outcomes in SVUH.

Method

Retrospective study of all TIPS procedures performed between 01/01/2015 to 31/12/2021, Data was collected from clinical letters, labs and radiology reporting systems. SPSS was used for data analysis.

Results

Of the 56 patients included, 57.1% were male, mean age was 51.6 years (SD±13.7). Most common aetiology was ArLD (41.1%), followed by autoimmune (21.4%). 5.4% had HCC, 10.7% had previous HE (≥grade II) and 19.6% had PVT. 7.1% of patients were on HE treatment (rifaximin and lactulose) at time of TIPS. Mean MELD was 13.25 (SD±6.6), 19.6% of patients had a MELD>18. 20% were Child-Pugh-A, 66.6% CP-B, 12.7% CP-C. Indications for TIPS were 38.2% variceal bleeding, 35.7% refractory ascites (RA), 10.7% prophylactic pre-surgery, 6.4% other. Post-TIPS, 46.4% developed HE and the only risk factor identified was age (57.6 v 47.9, p0.05). 16.1% patients died during admission, and mortality at 3, 6 and 12 months was 16.1%, 20% and 32.7%, respectively. In univariant analysis, risk factors associated with survival included TIPS indication (40months OV, 11.3days GV, 59m RA, 23m pre surgery, p0.001), MELD>18 (30 versus 62 months, p0.03), HCC (100% mortality versus 28.8%, p0.011) and Child-Pugh (30 months CP-A, 65m CP-B, 5m CP-C, p<0.001).

Conclusions

Risk factors associated with poor survival were gastric varices, MELD≥18, HCC pre-tips and Child PughC. Prophylactic rifaximin/lactulose should be considered pre-TIPS, particularly in older patients.