03:18 PM Abstract No. 171 Predictors of survival after transjugular intrahepatic portosystemic shunt (TIPS) creation with covered stents

Abstract

To assess the ability of MELD, MELD-Na, and laboratory variables to predict mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation using polytetrafluoroethylene (PTFE)-covered stents. This was an IRB-approved, HIPAA-compliant, single-center, retrospective cohort study, including 614 patients who underwent TIPS between 2005 and 2015 using PTFE-covered stents. Lab values, transplantation status, and survival were recorded and analyzed. One- and 3-month mortality, as well as overall survival (OS), were analyzed using the Area Under Receiver Operating Characteristic (AUROC) curves and compared using the paired samples t test. Transplant free survival (TFS) and OS were analyzed using univariate and multivariate Cox proportional hazards regression. P<0.05 was considered statistically significant. All patients received VIATORR stents (Gore & Associates, Flagstaff, AZ). Median age was 57 (range 19-85). The most common causes of cirrhosis were ETOH (n=238, 39%), viral (n=157, 26%) and NASH (n=139, 23%). The most common indications for TIPS were refractory ascites (n=282, 46%) and variceal bleeding (n=200, 33%). Median MELD was 14 and MELD-Na was 18 (ranges 6-44). Both MELD and MELD-Na accurately predicted early mortality at 1 month following TIPS, with AUROCs of 0.755 (p<0.01) and 0.701 (p<0.01). Similarly, at 3 months after TIPS, MELD and MELD-Na AUROCs were 0.658 (p<0.01) and 0.698 (p<0.01). MELD had a better predictive accuracy than MELD-Na for 1-month mortality (p=0.03). However, there was no difference in the prognostic ability of MELD and MELD-Na for mortality at 3 months (p=0.09). Hazard ratios (HRs) for MELD and MELD-Na in TFS were 1.09 [1.08, 1.11] and 1.10 [1.08, 1.11] (both p<0.01). HRs for MELD and MELD-Na in OS were 1.05 [1.03, 1.07] and 1.05 [1.03, 1.07] (both p<0.01). There was a statistically significant, progressive decrease in survival with increasing MELD scores (p<0.01). MELD and MELD-Na scores both predicted early mortality after TIPS using covered stents with similar accuracy. There was a progressively increasing mortality trend with increase in MELD scores, suggesting there may not be a strict cutoff for performing TIPS safely.