Abstract No. 646 Natural history of transjugular intrahepatic portosystemic shunts: long-term analysis of survival and protective factors

Abstract

To evaluate long-term survival in patients with portal hypertension treated with transjugular intrahepatic portosystemic shunts (TIPS) and to identify patient characteristics associated with improved survival. This is a multicenter retrospective cohort study. Patients who received TIPS between January 1, 2008 and December 31, 2014 were included in this study. Patient data was collected between the time of procedure and September 1, 2019. Statistical analysis was performed using SPSS (IBM, New York). 129 patients are included in this study, 84 males and 45 females, with a median age of 61. 32% of patients had chronic hepatitis C, 33% had a history of alcohol use disorder, and 19% of patients had nonalcoholic steatohepatitis (NASH). The remainder of patients had miscellaneous etiologies of cirrhosis including autoimmune biliary cirrhosis, hepatitis B, and cystic fibrosis. 77% of patients had variceal bleeding and 34% of patients had refractory ascites prior to their procedures. 14% of patients had a history of hepatic encephalopathy. The technical success rate was 91% and overall complication rate was 30%. 1-, 3-, 5-, 7-, and 10-year survival rates are as follows: 93%, 74%, 58%, 38%, and 15%. 19% of patients had at least one episode of ascites requiring therapeutic paracentesis and 16% of patients experienced variceal hemorrhage during the follow-up period. 28% of patients required revision to expand their TIPS and 4% of patients required revision to constrain their TIPS. 56% of patients had episodes of hepatic encephalopathy during the follow-up period requiring hospitalization. 25% of patients experienced a decline in renal function of at least one stage. 21% of patients underwent subsequent liver transplantation. Female sex, preprocedural variceal bleeding rather than ascites, and NASH etiology of cirrhosis were associated with higher rates of overall survival. TIPS are crucial for many patients with symptomatic portal hypertension. Female sex, preprocedural variceal bleeding rather than ascites, and NASH as etiology of cirrhosis are associated with increased rates of long-term survival.