Age-related Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunts

Suraweera, Duminda; Jimenez, Melissa; Viramontes, Matthew R.; Jamal, Naadir; Grotts, Jonathan; Elashoff, David; Lee, Edward W.; Saab, Sammy

doi:10.1097/mcg.0000000000000541

Cited by 12 publications

(16 citation statements)

References 30 publications

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“…Bei modernen gecoverten Stents führt das Unterschreiten einer unteren Grenze des portosystemischen Druckgradienten < 5 mm zu einem deutlich erhöhten Risiko für eine HE oder ein Leberversagen [702]. Vorhersageparameter für eine HE sind: Alter über 65 Jahre [703,704], frühere HE [673,705], Child-Pugh-Score > 10, MELD-Score > 14 [706], niedriges Serumnatrium [576] und eine Hyperbilirubinämie [698]. Neben dem MELD-Score stellte auch das Vorliegen einer Sarkopenie einen unabhängigen Risikofaktor für das Auftreten einer HE nach TIPS-Anlage dar [213].…”

Section: Kommentarunclassified

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

et al. 2019

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ZusammenfassungDie Leitlinie Komplikationen der Leberzirrhose der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) ersetzt die Leitlinie aus dem Jahr 2011. Sie basiert auf den Empfehlungen der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) für eine evidenzbasierte Konsensus-Leitlinie der Entwicklungsstufe S2k und wurde interdisziplinär unter Beteiligung aller relevanten Fachgesellschaften und der Patientenvertretung erstellt. Neben den in der Vorgängerversion behandelten Kapiteln Aszites, spontan bakterielle Peritonitis, hepatorenales Syndrom, hepatischer Hydrothorax und hepatopulmonales Syndrom wurden die Kapitel Diagnostik und Therapie der Hepatischen Enzephalopathie neu aufgenommen.

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Section: Kommentarunclassified

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

et al. 2019

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“…Most studies that have specifically evaluated TIPS outcomes in older populations have defined elderly to be 60 [16] or 65 [14,15] years and older or have not reported rates of post-TIPS encephalopathy or readmission rates. These studies had total sample sizes ranging from 23-64 patients.…”

Section: Discussionmentioning

confidence: 99%

“…All three died within 30 d post TIPS despite a low baseline MELD ranging from 10-16, suggesting that age over 80 may be associated with a higher mortality than seen with patients in their seventies. [12,14,[17][18][19][20][21]27]. We had too few patients 80 years and older to study as a separate group.…”

Section: Discussionmentioning

confidence: 99%

“…Prior retrospective studies have evaluated TIPS outcomes in patients 60 years and older [14][15][16] reporting increased rates of encephalopathy or short-term mortality in this older age group [12,14,[17][18][19][20][21]. The purpose of our study was to report outcomes after TIPS in patients 70 years of age and older including rates of HE and 30 d readmissions after TIPS.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes After Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients 70 Years and Older

Adlakha

Russo

2020

JCM

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Transjugular intrahepatic portosystemic shunt (TIPS) is effective at treating ascites and variceal bleeding but may be associated with increased morbidity and mortality in older patients. Our aim was to report outcomes in patients 70 years and older who underwent TIPS because data are limited in this population. We performed a retrospective review of patients who underwent TIPS at our institution over 10 years. We matched those 70 years and older to those 50–59 years old by year of TIPS and the Model for End-Stage Liver Diseae-Sodium (MELD-Na). Thirty-day readmissions were higher in the elderly group (n = 50) compared to the younger group (n = 50), n = 17 (34%) and n = 6 (12%) (p = 0.02), respectively. Readmissions for post-TIPS hepatic encephalopathy (HE) in the older and younger groups were n = 14 (28%) and n = 5 (10%) (p = 0.04), respectively. Thirty-day mortality was higher in the older group compared to the younger group, but the difference was not statistically significant, 24% and 12%, respectively (p = 0.19). TIPS can be performed safely in patients 70 years and older, but the overall readmissions, and specifically for HE, were significantly higher in older patients. Patients 70 years and older should be followed closely after TIPS, and early introduction of treatment for encephalopathy should be considered.

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“…The authors attributed this finding to the age-related physiologic decline in functional hepatic reserve as well as to the increased burden of comorbidities seen in older patients. In a case-control study, Suraweera et al 28 found a trend toward greater hospitalizations and mortality in patients !65 years old.…”

Section: Advanced Agementioning

confidence: 97%

Transjugular Intrahepatic Portosystemic Shunts in High-Risk Patients

Shin

Johnson

et al. 2020

Digestive Disease Interventions

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Cirrhosis with complications of portal hypertension portends a poor prognosis. Transjugular intrahepatic portosystemic shunts (TIPS) can successfully treat some of these complications in select patients. While the safety and efficacy of TIPS have improved significantly over the past decade, certain patients are categorized as high-risk based on various demographic, laboratory, and comorbid factors. Herein, we provide an in-depth review of TIPS in these settings, including high model for end-stage liver disease score, hepatic malignancy, advanced age, cardiac disease, renal dysfunction, and pregnancy, and discuss their impact on patient selection and procedural considerations.

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Age-related Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunts

Abstract: The results of this study suggest event-free survival is similar between nonelderly and elderly patients. Although statistically significant, there is a tendency toward greater mortality and hospitalization in the elderly.

Cited by 12 publications

References 30 publications

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

Outcomes After Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients 70 Years and Older

Transjugular Intrahepatic Portosystemic Shunts in High-Risk Patients

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