Transjugular Intrahepatic Portosystemic Shunts (TIPS) is Associated with Increased Mortality in Patients After Orthotopic Liver Transplantation (OLT): Presidential Poster

Abstract

Purpose: The safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) is not well studied in patients following liver transplantation. Our aim was to study the safety and efficacy of TIPS in patients following liver transplantation. Methods: Twenty-seven (27) orthotopic liver transplantation (OLT) patients and fifty-six (56) age and sex matched nontransplant patients were studied from a prospectively maintained TIPS database over the time period 2001-2011. Demographics and clinical information, including pre-TIPS Model for End-Stage Liver Disease (MELD) and Child-Pugh scores, were obtained. Univariable analysis was used to compare characteristics between two groups. A multivariable proportional hazards model was constructed to assess factors associated with mortality. Log Rank testing was done to compare survival distributions between groups. Results: In the OLT group, 63% of patients were male, and mean age was 47.1±16.5 years. The most common underlying liver disease prior to OLT was cirrhosis secondary to Hepatitis C (N=7, 25.6%). TIPS was performed at a median of 53.1 months (range=1.9-1221.3) after transplantation. The most common indications for TIPS in this group were refractory ascites (N=12, 44.4%) and bleeding esophageal varices (N=7, 25.9%). There were no significant differences in demographics, pre-TIPS MELD and Child-Pugh scores, and complication rates between groups. However, mortality in the OLT group was significantly higher than patients in the non-OLT group (59.2% vs 25.0%, p=0.02). The median survival in patients in the OLT group was 64.5 days (range = 3.0-1539.0) as compared to 512.5 days (range = 77-3488) for patients in the non-OLT group after TIPS (p <0.001). Both pre-TIPS MELD (RR 4.0, 95% CI: 0.6-19.7) and Child-Pugh scores (RR 0.7, 95% CI: 0.2-2.7) were not associated with an increase in mortality. No other factors evaluated were associated with an increased mortality risk (Table 1).Table 1: Factors associated with mortalityConclusion: Immediate complications were comparable between OLT and non-transplant patients. Survival rates in OLT patients after TIPS creation is lower compared to non-transplant patients, with majority of deaths (58.8%) occurring within the first 90 days following TIPS creation. MELD and Child-Pugh scores were not associated with increased mortality in this study. Based on the results of our study, OLT patients who are ineligible for retransplantation should not be considered for TIPS creation.