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Published in: Abdominal Radiology 6/2021

01-06-2021 | Hypertension | Special Section : Liver Transplantation

Is 70 the new 50? Complications and outcomes of transjugular intrahepatic portosystemic shunt in older versus younger patients

Authors: Roy U. Bisht, Margaret C. Liu, Jenna E. Koblinski, Paul Kang, Mark N. Wong, Ester C. Little

Published in: Abdominal Radiology | Issue 6/2021

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Abstract

Background

An increased risk of complications of TIPS in patients older than 65 years of age has been described, but data is limited. The objective of this study was to determine if the rate of complications post-TIPS differs in patients 65 or younger, compared to those older than 65 years of age.

Methods

A retrospective chart review was performed for all patients who underwent TIPS procedure at Banner—University Medical Center Phoenix, from 2010 to 2018, specifically focusing on complications and outcomes post-TIPS. In total, 402 patients were included in this analysis. Complications included portosystemic encephalopathy, post-TIPS infection, acute kidney injury requiring hemodialysis, hemorrhage, respiratory complications, need for transplant, or death.

Results

A total of 402 patients were included and divided into two groups: 300 (74.6%) were 65 years or younger (ages 53 ± 9), and 102 were older than 65 years (70 ± 5 (p < 0.001)). There were no statistically significant differences between age groups when comparing portosystemic encephalopathy, post-TIPS infection, acute kidney injury, respiratory complications, need for transplant, or death.

Conclusion

In this large, single-center cohort, there was no statistically significant difference in the rate of complications of TIPS between the two age groups. Based on our results, TIPS procedure is an equally safe option for properly selected patients with complications of portal hypertension, regardless of age.
Literature
1.
go back to reference Colapinto RF, Stronell RD, Gildiner M, et al. Formation of intrahepatic portosystemic shunts using a balloon dilatation catheter: Preliminary clinical experience. Am J Roentgenol 1983;140:709-714.CrossRef Colapinto RF, Stronell RD, Gildiner M, et al. Formation of intrahepatic portosystemic shunts using a balloon dilatation catheter: Preliminary clinical experience. Am J Roentgenol 1983;140:709-714.CrossRef
2.
go back to reference Boyer T, Haskal Z. AASLD Practice Guidelines: The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension. Hepatology 2010;51:1-17.CrossRef Boyer T, Haskal Z. AASLD Practice Guidelines: The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension. Hepatology 2010;51:1-17.CrossRef
3.
go back to reference Bureau C, Garcia-Pagan JC, Otal P, et. al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: Results of a randomized study. Gastroenterology 2004;126:469-475.CrossRef Bureau C, Garcia-Pagan JC, Otal P, et. al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: Results of a randomized study. Gastroenterology 2004;126:469-475.CrossRef
4.
go back to reference Kraglund F, Jepsen P, Amanavicius N, et al. Long-term effects and complications of the transjugular intrahepatic portosystemic shunt: a single-centre experience. Scand J Gastroentero 2019;54:899-904.CrossRef Kraglund F, Jepsen P, Amanavicius N, et al. Long-term effects and complications of the transjugular intrahepatic portosystemic shunt: a single-centre experience. Scand J Gastroentero 2019;54:899-904.CrossRef
5.
go back to reference Lee E, Kuei A, Saab S, et al. Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt. World J Gastroenterology 2016;22:5780-5789.CrossRef Lee E, Kuei A, Saab S, et al. Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt. World J Gastroenterology 2016;22:5780-5789.CrossRef
6.
go back to reference McCormick PA, Dick R, Burroughs AK. Review article: the transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension. Aliment Pharmacol Ther 2007;8:273-282.CrossRef McCormick PA, Dick R, Burroughs AK. Review article: the transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension. Aliment Pharmacol Ther 2007;8:273-282.CrossRef
7.
go back to reference Bettinger D, Knüppel E, Euringer W, et al. Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPSS) in 40 patients with hepatocellular carcinoma. Aliment Pharmacol Ther 2014;41:126-136.CrossRef Bettinger D, Knüppel E, Euringer W, et al. Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPSS) in 40 patients with hepatocellular carcinoma. Aliment Pharmacol Ther 2014;41:126-136.CrossRef
8.
go back to reference Casadaban LC, Parvinian A, Zivin SP, et al. MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort. Ann Hepatol 2015;14:380-388.CrossRef Casadaban LC, Parvinian A, Zivin SP, et al. MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort. Ann Hepatol 2015;14:380-388.CrossRef
9.
go back to reference Ferral H, Gamboa P, Postoak D, et al: Survival after elective transjugular intrahepatic portosystemic shunt creation: Prediction with Model for End-Stage Liver Disease Score. Radiology 2004;231:231-236.CrossRef Ferral H, Gamboa P, Postoak D, et al: Survival after elective transjugular intrahepatic portosystemic shunt creation: Prediction with Model for End-Stage Liver Disease Score. Radiology 2004;231:231-236.CrossRef
10.
go back to reference Loffroy R, Favelier S, Pottecher P, et al. Transjugular intrahepatic portosystemic shunt for acute variceal gastrointestinal bleeding: Indications, techniques and outcomes. Diagnostic and Interventional Imaging 2015;96:745-755.CrossRef Loffroy R, Favelier S, Pottecher P, et al. Transjugular intrahepatic portosystemic shunt for acute variceal gastrointestinal bleeding: Indications, techniques and outcomes. Diagnostic and Interventional Imaging 2015;96:745-755.CrossRef
11.
go back to reference Ronald J, Wang Q, Choi S, et al. Albumin-bilirubin grade versus MELD score for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation. Diagn Interv Imaging 2018;99:163-168.CrossRef Ronald J, Wang Q, Choi S, et al. Albumin-bilirubin grade versus MELD score for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation. Diagn Interv Imaging 2018;99:163-168.CrossRef
12.
go back to reference Schepke M, Roth F, Fimmers R, et al: Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing trans- jugular intrahepatic portosystemic shunting. Am J Gastroenterol 2003;98:1167-1174.CrossRef Schepke M, Roth F, Fimmers R, et al: Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing trans- jugular intrahepatic portosystemic shunting. Am J Gastroenterol 2003;98:1167-1174.CrossRef
13.
go back to reference Siramolpiwat S. Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications. World J Gastroenterolg 2014;20:16996.CrossRef Siramolpiwat S. Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications. World J Gastroenterolg 2014;20:16996.CrossRef
14.
go back to reference Liu M, Bisht R, Koblinski J, et al. “Is 70 the New 50? Complications and Outcome of TIPS in Older Versus Younger Patients.” Poster presentation at the 2018 AASLD Liver Meeting, November 2018, San Francisco, CA. Liu M, Bisht R, Koblinski J, et al. “Is 70 the New 50? Complications and Outcome of TIPS in Older Versus Younger Patients.” Poster presentation at the 2018 AASLD Liver Meeting, November 2018, San Francisco, CA.
15.
go back to reference Dhanasekaran R, Gonzales P, West J, et al. Predictors of early mortality post transjugular intrahepatic portosystemic shunts and the role of hepatic venous pressure gradient. Gastrointest Interv 2012;1:63–68.CrossRef Dhanasekaran R, Gonzales P, West J, et al. Predictors of early mortality post transjugular intrahepatic portosystemic shunts and the role of hepatic venous pressure gradient. Gastrointest Interv 2012;1:63–68.CrossRef
16.
go back to reference Parvinian A, Shah K, Couture P, et al. Older Patient Age May Predict Early Mortality after Transjugular Intrahepatic Portosystemic Shunt Creation in Individuals at Intermediate Risk. J Vasc Interv Radiol 2013;24:941–946.CrossRef Parvinian A, Shah K, Couture P, et al. Older Patient Age May Predict Early Mortality after Transjugular Intrahepatic Portosystemic Shunt Creation in Individuals at Intermediate Risk. J Vasc Interv Radiol 2013;24:941–946.CrossRef
17.
go back to reference Lerrigo R, Beste L, Leipertz S, et al. Characteristics and outcomes of transjugular intrahepatic portosystemic shunt recipients in the VA Healthcare System. Eur Journal of Gastroenterol Hepatol 2016;28:667–675.CrossRef Lerrigo R, Beste L, Leipertz S, et al. Characteristics and outcomes of transjugular intrahepatic portosystemic shunt recipients in the VA Healthcare System. Eur Journal of Gastroenterol Hepatol 2016;28:667–675.CrossRef
18.
go back to reference Suraweera D, Jimenez M, Viramontes M, et al. Age-related Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunts. Journal of Clinical Gastroenterology. 2017;51(4):360-363.CrossRef Suraweera D, Jimenez M, Viramontes M, et al. Age-related Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunts. Journal of Clinical Gastroenterology. 2017;51(4):360-363.CrossRef
Metadata
Title
Is 70 the new 50? Complications and outcomes of transjugular intrahepatic portosystemic shunt in older versus younger patients
Authors
Roy U. Bisht
Margaret C. Liu
Jenna E. Koblinski
Paul Kang
Mark N. Wong
Ester C. Little
Publication date
01-06-2021
Publisher
Springer US
Published in
Abdominal Radiology / Issue 6/2021
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-020-02533-3

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