D0516 - Outcomes of Patients With Cirrhosis Treated with Indwelling Catheters and TIPS for Refractory Ascites: A 14-Year Single Center Review

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

NA

Natasha Adlakha, MD

Atrium Health-Carolinas Medical Center
Charlotte, NC

Natasha Adlakha, MD¹, Mark Russo, MD, MPH, FACG²
¹Atrium Health-Carolinas Medical Center, Charlotte, NC; ²Atrium Health Wake Forest Baptist Medical Center, Charlotte, NC

Introduction: Refractory cirrhotic ascites is defined as ascites that cannot be mobilized or recurs after paracentesis despite sodium restriction and diuretic therapy that occurs in 5-10% of patients with cirrhosis and is associated with poor survival.^1,2 Treatment options include serial paracentesis, transjugular intrahepatic portosystemic shunt (TIPS), indwelling abdominal catheters (IAC), and liver transplantation. Current guidelines do not recommend placement of permanent IAC due to few, low quality studies lacking safety and efficacy data on the topic.³ In addition, there may be an increased risk of infection with IAC. We sought to describe the natural history and outcomes associated with IAC.

Methods: We retrospectively reviewed patients with cirrhosis treated for refractory ascites between 2007-2021 at a single center in Charlotte, NC with TIPS or IAC placement. Patients undergoing IAC insertion for refractory ascites were not TIPS candidates. We excluded those with malignant ascites or lost to follow up beyond day after intervention. Patient demographics, clinical and laboratory data, time to follow up, survival time from intervention, and cause of death were recorded where available.

Results: A total of 136 patients with cirrhosis underwent TIPS or IAC placement for refractory ascites, of which 4 were excluded due to lack of follow up after insertion leaving 132 patients for analysis (Table 1). The mean MELD at time of IAC or TIPS placement was 23.7 and 12.9 respectively. While 34.6% patients with TIPS placement were found to be deceased by the end of the study period mean follow up of 357 days, the 60 day and 6 month mortality rate was only 6.5% and 7.5% respectively. Ninety-six percent of patients died after IAC placement during the study period mean follow up of 106 days and 76% died within 60 days. The most common cause of death was liver failure for both TIPS and IAC groups, 35.1% and 87.5% respectively.

Discussion: Patients treated with IAC rarely died from catheter-related complications, but instead from progressive liver decompensation and failure. Sixty-day mortality was high at 76%. These data may aid in planning for end of life care and inform family of the anticipated prognosis.

	TIPS (n=107)	Catheter (n=25)
Age at Catheter Insertion	56.8	60.8
Sex (male, %)	62.6	80
Cirrhosis Etiology - Alcohol /Hepatitis B or C/Non Alcoholic Fatty Liver Disease/Other (%)	46/23/28/2.4	28/48/16/8
Encephalopathy / Spontaneous Bacterial Peritonitis /History of Variceal Bleeding (%)	25/3.7/41	60/28/28
Total bilirubin (mg/dL, average + standard deviation)	1.44 + 0.75	4.8+5.1
MELD-Na* at Intervention (average + standard deviation)	12.9 +4.3	23.7 +6.9
Mean follow up (days)	357.6	106
60 day mortality (%)	6.5	76
6 month mortality (%)	7.5	88

Table: Table 1. Patient demographics and characteristics. (*MELD= Model for End Stage Liver Disease-Sodium)

Disclosures:

Natasha Adlakha indicated no relevant financial relationships.

Mark Russo: Moderna – Advisor or Review Panel Member.

Natasha Adlakha, MD¹, Mark Russo, MD, MPH, FACG². D0516 - Outcomes of Patients With Cirrhosis Treated with Indwelling Catheters and TIPS for Refractory Ascites: A 14-Year Single Center Review, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.