Impact of transjugular intrahepatic portosystemic shunt (tips) on waitlist and post-transplant outcomes in liver transplantation

Document Type

Conference Proceeding

Publication Date

10-1-2021

Publication Title

Hepatology

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) has a major role in the management of recurrent esophageal varices, and refractory ascites. However, the effect of TIPS being performed before or after listing remains unknown. This study aims to determine the impact of the timing of TIPS on waitlist and post-transplant outcomes in liver transplantation (LT). Methods: We analyzed the data from United Network for Organ Sharing (UNOS) registry for 115,634 adult patients (≥18 years) who were listed between 2010 and 2021 and identified 9,368 LT candidates who had TIPS prior to listing. Patients listed for multi-organ transplant, and re-transplant were excluded. 90-day waitlist outcomes were compared between those groups using Fine-Gray hazard regression models by adjusting for patient characteristics at listing. We then looked at patients who underwent single-organ, deceased LT during the same period and categorized them based on the timing of TIPS: no TIPS (n= 54,192), TIPS prior to listing (n= 3,601), and TIPS between listing and transplant (n= 2,019). Post-LT outcomes at 1-month, and 1-year were compared according to Cox proportional hazard models, adjusting for recipient and donor characteristics at transplant. Results: The median MELD score for LT candidates at listing was higher in patients who had TIPS prior to listing compared to the other groups (No TIPS or TIPS after listing 16; TIPS prior to listing 17; p<0.001). However, LT recipients in the 3 groups had similar median MELD scores at transplant (No TIPS 22; TIPS prior to listing 21; TIPS between listing and transplant 21; p=0.179). The median days spent on the waitlist was significantly longer for patients who received TIPS between listing and transplant compared to those who had TIPS prior to listing, and those without TIPS respectively (243 vs. 88 vs. 77 days; p<0.001). LT candidates who had TIPS prior to listing had a lower 90-day transplant probability (aHR 0.88; 95% CI 0.84-0.92; p=0.005) and were associated with worse 1-month and 1-year patient/graft survival compared to patients without TIPS (Table 1). However, patients who had TIPS after being listed had a similar transplant probability at 90-days (aHR 1.07; 95% CI 0.99-1.16; p=0.110) and had worse post-transplant outcomes at 1-month (graft loss: aHR 1.34, p=0.009; mortality: aHR 1.44, p=0.005) compared to patients without TIPS (Table 1). Conclusion: TIPS prior to transplant increases the risk of early post-transplant graft loss and mortality. Patient in which TIPS might be considered may benefit from access to early transplantation to improve their post-LT outcomes.

Volume

74

Issue

SUPPL 1

First Page

851A

Last Page

852A

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