Outcomes of TIPS for ascites as a function of baseline renal function.
Selim R, Getzen T, and Moonka D. Outcomes of TIPS for ascites as a function of baseline renal function. Hepatology 2017; 66:952A.
BACKGROUND Transjugular intrahepatic portosystemic shunts (TIPS) are used to treat ascites secondary to cirrhosis. There is limited data on the safety and efficacy of this modality in patients with significant renal insufficiency (RI). In this study, we evaluate patient outcomes with TIPS with an emphasis on baseline renal function. METHODS 88 patients who underwent TIPS for ascites and/or hepatic hydrothorax were analyzed retrospectively. Patients were divided into 3 groups based on calculated GFR (MDRD); <45 mL/min (Group 1), 45‐60 (Group 2), and >60 (Group 3). Outcomes measured include change in renal function, number of paracentesis/thoracentesis, hepatic encephalopathy (HE) and mortality. RESULTS There were 24, 24, and 40 patients in Groups 1, 2 and 3, respectively. The mean ages for Group 1, 2 and 3 were 59, 58 2 and 55 7 years, mean MELD‐Na at baseline were 18.29, 16.62, 15.1, mean creatinine were 1.99, 1.36, and 0.9 mg/dl and mean GFR were 35.15, 53.49, and 84.6 ml/min. Mean number of para/thora performed in the 90 days prior to TIPS were 7.71, 8.01, and 9.9.90 and 180‐day mortality was 4% and 17%, 11% and 8%, and 7.5% and 10% in Groups 1, 2 and 3, respectively. 33.3%, 14.2% and 23.5% of patients were transplanted at 180 days post‐TIPS. The mean number of para/thora required in the 90 days after TIPS declined to 1.14, 3.77, and 2.83 for the 3 groups. Length of stay (LOS) following TIPS increased for those with hydrothorax vs without: 5.47 vs 3 days (P=0.012). Those in Group 1 experienced an average increase in GFR of 12.01 mL/min at 30 days (P= 0.002) and 9.76 at 90 days (P=0.007). Those in Group 2 had an increase in GFR of 4.34 at 30 days and 10.01 at 90 days (NS). Those in Group 3 had an average increase in GFR of 8.61 at 30 days and a decrease of 7.31 at 90 days (NS). Post‐TIPS, the proportion of patients with hepatic encephalopathy was 67%, 54%, and 48% for Group 1, 2 and 3. For those in Group 1 and 2 only, there was a greater increase in HE if the change in portosystemic gradient after TIPS was >10 vs <10 mmHg (78% vs 33% for Group 1 and 44% vs 28% for those in Group 2) CONCLUSION Our results illustrate that TIPS is reasonably safe and effective in patients with ascites/hydrothorax with significant renal dysfunction. This group experienced a significant increase in GFR after the procedure and had comparable mortality compared to those with preserved renal function. All groups had a significant decline in the need for paracentesis. Patients with RI had more HE and this was especially marked in patients with a change in portosystemic gradient > 10 mmHg. Those with hepatic hydrothorax had longer hospital stays following TIPS.