Impact of Chronicity of Renal Dysfunction on Post-TIPS Outcomes

Hingorani, Neha; Catron, Tom; Al, Ahmed Kamel Abdel; Singal, Ashwani K.

doi:10.14309/00000434-201710001-00921

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“…Patients with chronic kidney disease would be less likely to have improvements in renal function from increased effective circulating blood volume after TIPS when compared with patients with transient acute kidney insufficiency. In small single-center studies, chronic kidney disease has been shown to be an independent risk factor for increased mortality after TIPS (29–31). Our findings are limited by not having accurate knowledge of duration or severity of underlying chronic kidney disease or information about the trajectory of renal function at that time of TIPS in this retrospective cohort.…”

Section: Discussionmentioning

confidence: 99%

Outcomes After TIPS for Ascites and Variceal Bleeding in a Contemporary Era—An ALTA Group Study

et al. 2021

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INTRODUCTION: Advances in transjugular intrahepatic portosystemic shunt (TIPS) technology have led to expanded use. We sought to characterize contemporary outcomes of TIPS by common indications. METHODS: This was a multicenter, retrospective cohort study using data from the Advancing Liver Therapeutic Approaches study group among adults with cirrhosis who underwent TIPS for ascites/hepatic hydrothorax (ascites/HH) or variceal bleeding (2010–2015). Adjusted competing risk analysis was used to assess post-TIPS mortality or liver transplantation (LT). RESULTS: Among 1,129 TIPS recipients, 58% received TIPS for ascites/HH and 42% for variceal bleeding. In patients who underwent TIPS for ascites/HH, the subdistribution hazard ratio (sHR) for death was similar across all Model for End-Stage Liver Disease Sodium (MELD-Na) categories with an increasing sHR with rising MELD-Na. In patients with TIPS for variceal bleeding, MELD-Na ≥20 was associated with increased hazard for death, whereas MELD-Na ≥22 was associated with LT. In a multivariate analysis, serum creatinine was most significantly associated with death (sHR 1.2 per mg/dL, 95% confidence interval [CI] 1.04–1.4 and 1.37, 95% CI 1.08–1.73 in ascites/HH and variceal bleeding, respectively). Bilirubin and international normalized ratio were most associated with LT in ascites/HH (sHR 1.23, 95% CI 1.15–1.3; sHR 2.99, 95% CI 1.76–5.1, respectively) compared with only bilirubin in variceal bleeding (sHR 1.06, 95% CI 1.00–1.13). DISCUSSION: MELD-Na has differing relationships with patient outcomes dependent on TIPS indication. These data provide new insights into contemporary predictors of outcomes after TIPS.

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Section: Discussionmentioning

confidence: 99%