P0706 - Long Term Outcomes of TIPS for Patients With Refractory Variceal Bleeding and Ascites: “A Real World Experience” From a Single Large Center

Sajid Jalil, MD¹, Alex Liu, MD¹, Victoria Alexander, MD¹, Ali Rikabi, MD¹, Mina Makary, MD¹, Romaisa Pervez, MSc(Epi)², Sean G. Kelly, MD³, Lanla Conteh, MD, MPH¹, Alice Hinton, ¹, Anthony Michaels, MD¹, James Hanje, MD¹, Khalid Mumtaz, MBBS^1
1The Ohio State University Wexner Medical Center, Columbus, OH; ²Lawson Health Research Institute, Columbus, OH; ³The Ohio State University Wexner Medical Center, Coumbus, OH

Introduction: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective procedure for the management of refractory variceal bleeding and ascites. Current AASLD guidelines recommend using TIPS as a bridge to liver transplants. We report our experience with TIPS and its outcomes.

Methods: Demographic, clinical, radiographic and procedural data of all patients who underwent TIPS was collected retrospectively from 2000-2018 at The Ohio State University, Columbus, Ohio. 225 patients met the study criteria for inclusion. Outcomes studied were reduction in diuretics use and paracentesis, length of stay, post TIPS hepatic encephalopathy (HE), 30-day readmission, rates of TIPS revision, need for liver transplantation and overall mortality.

Results: The mean age of patients who underwent TIPS was 58.5 ±11 with the majority males (55%). Predominantly patients were Caucasians (89.9%) and African Americans (6.7%). The majority of TIPS (56.9%) were performed as urgent (transfer + ED admissions) and for variceal bleeding (esophageal + gastric= 43.5%) followed by diuretic resistance ascites (37.6%). The most common etiology of cirrhosis was alcohol (30.45%) followed by NASH (30.0%) and chronic hepatitis C 14.09%. Hepatocellular carcinoma was present in 6.4% of the patients. The mean MELD score prior to TIPS was 14.14 ± 7.67 and the CTP score was 8.16 ± 1.66. Post TIPS MELD score was 15.84 ± 8.48 and CTP score 8.48 ± 1.74. Complications of TIPS were low (2.8%). Post TIPS HE developed in 28.8% and the 30-day readmission rate was 29.6%. While the majority of patients (64.9%) still required diuretics post TIPS, dose reduction was achieved in 27.7%, however, the majority did not require ongoing paracentesis (77%). The average length of stay was 9.97 days ± 7.48. Index admission mortality was 9.7% while overall mortality was 40% in this cohort. On multivariate regression analysis, the diagnosis of alcoholic cirrhosis (p = 0.012), increased CTP score (p = < 0.001) increase in INR (0.01) and rebleeding (p = 0.008) were predictors of 30-day readmission. Post TIPS delta MELD (p = 0.013), rebleed (p = 0.007) and delta INR (p = 0.034) were associated with increased risk of overall mortality.

Discussion: This is one of the largest real-world single-center experience of TIPS in the United States. This real-world data on outcomes is a source of helpful information for the patients undergoing evaluation for TIPS. Careful selection of patients is key to successful TIPS in patients with refractory variceal bleed and ascites.



Disclosures:


Sajid Jalil, MD¹, Alex Liu, MD¹, Victoria Alexander, MD¹, Ali Rikabi, MD¹, Mina Makary, MD¹, Romaisa Pervez, MSc(Epi)², Sean G. Kelly, MD³, Lanla Conteh, MD, MPH¹, Alice Hinton, ¹, Anthony Michaels, MD¹, James Hanje, MD¹, Khalid Mumtaz, MBBS¹. P0706 - Long Term Outcomes of TIPS for Patients With Refractory Variceal Bleeding and Ascites: “A Real World Experience” From a Single Large Center, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.