4:12 PM Abstract No. 290 Changes in kidney function and model of end-stage liver disease score in diabetic patients undergoing the transjugular intrahepatic portosystemic shunt procedure

Abstract

Diabetes is an important comorbidity present in up to 30% of patients with liver cirrhosis. The purpose of our study was to determine the impact of diabetes on the renal function and survival after transjugular intrahepatic portosystemic shunt (TIPS) procedure. We reviewed the medical records of 387 patients who had successful TIPS between September 2004 and September 2016. The patients were divided into two groups; group A (diabetics, n = 186) and group B (non-diabetics, n = 201). The glomerular filtration rate (GFR) and model for end-stage liver disease (MELD) score before and within 1 month after TIPS placement were recorded in each group. A threshold GFR and MELD score associated with mortality was estimated in each group. The study included 261 (62%) males, 373 (88%) whites, and 186 (45%) diabetics, with an average age of 59 (SD = 9.7) for diabetics and 54.7 (SD = 9.6) for non-diabetics. Before TIPS, there was a statistically significant difference between diabetics and non-diabetics in mean GFR (63.3 versus 80.9 respectively, p<0.0001) and in MELD score (13.3 versus 12.3 respectively, p = 0.0123). In spite of the significant change in MELD score after TIPS in diabetics and non-diabetics (p<0.0001), there was no significant change in the GFR after TIPS in either diabetics (p = 0.3345) or non-diabetics (p = 0.5065). Lower pre-TIPS GFR was significantly associated with mortality in diabetics [HR = 0.989,CI (0.98-0.99),p = 0.039), while higher pre-TIPS MELD score was associated with mortality in both diabetics [HR = 1.07,CI (1.00-1.14),p = 0.0398] and non-diabetics [HR = 1.08,CI (1.03-1.14),p = 0.001]. The threshold of pre-TIPS GFR and MELD score in discriminating survival in diabetics was 54 (p = 0.039) and 12 (p = 0.0398). Non-diabetic status was a significant contributor to survival [HR = 0.74,CI (0.55-0.99),p = 0.043]. TIPS does not significantly change the GFR in diabetics. However, pre-TIPS lower GFR and higher MELD score were associated with mortality after TIPS in diabetic patients. The best survival outcome was seen in patients with GFR > 54 and MELD < 12, and the absence of diabetes was a significant contributor to survival in cirrhotic patients undergoing TIPS.