3:36 PM Abstract No. 321 Mitigation of sarcopenia after Denver shunt placement in patients with refractory ascites

Abstract

In patients with ascites due to portal hypertension, TIPS placement results in muscle gain and decreased overall mortality. When TIPS is contraindicated, peritoneovenous shunt (Denver Shunt) is a viable alternative. We evaluated the effect of Denver Shunt placement on metrics of sarcopenia in patients with refractory ascites. IRB-approved single-institution retrospective analysis of all patients undergoing Denver shunt placement from 2009-2019 and having clinical follow-up with baseline and postplacement cross-sectional imaging (n = 37). Two patients were excluded from the analysis for receiving TIPS prior to or during the study period. Medical records were reviewed for demographics, referring indication, laboratory studies, and performance status. Axial muscle area measurements (psoas, paraspinal, total abdominal wall) were performed using free-hand region of interest technique by a board eligible radiologist. Statistical analysis was performed with Fisher’s exact test and Student’s t test, with a P value of < 0.05 chosen as the threshold for statistical significance. For all causes of ascites, the mean age of patients was 57 with a male predominance (66%). Median imaging follow-up was 148 days after shunt placement. The most common indications for Denver Shunt placement were metastatic disease or cirrhosis. A subset analysis demonstrated an increase in aggregate psoas muscle area following shunt placement (12.7 vs. 14.6 cm2, P = 0.02), with no significant difference in paraspinal muscle (44.2 vs. 45.2 cm2, P = 0.49) or total abdominal wall muscle (58.9 vs. 56.7 cm2, P = 0.30). Patients that demonstrated muscle gain, regardless of the referring indication, were younger (55 vs. 62, P = 0.14) and had lower baseline serum albumin levels (2.7 vs. 3.2, P = 0.02); these patients also showed an increase in serum albumin concurrent with truncal muscle growth (2.7 vs. 3, P = 0.08). In certain patients with refractory ascites not amenable to TIPS placement, Denver Shunt is an effective alternative that can promote growth of the psoas muscle, a reliable surrogate for total body skeletal muscle.