Association Between Older Age and TIPS-Related Hospitalization Following Shunt Placement

Area of Science:

• Hepatology
• Interventional Radiology
• Geriatric Medicine

Background:

• Portal hypertension complications increase with liver disease progression.
• Transjugular intrahepatic portosystemic shunt (TIPS) insertion manages many portal hypertension complications.
• The impact of patient age on TIPS outcomes remains debated.

Purpose of the Study:

• To evaluate the effect of age on outcomes after TIPS insertion.
• To compare TIPS-associated complications and hospital admissions in patients < 70 years and ≥ 70 years.
• To identify predictors of liver-related hospital admission within 12 months post-TIPS.

Main Methods:

• Retrospective, bicentric cohort study.
• Inclusion of 593 patients who underwent TIPS between 2006 and 2016.
• Primary outcome: predictors of liver-related hospital admission within 12 months, comparing age groups (<70 vs. ≥70).

Main Results:

• No significant difference in 12-month post-TIPS complication admissions between elderly (≥70) and non-elderly (<70) patients (29.2% vs. 29.0%, p=0.91).
• Predictors of 12-month admission included pre-existing diabetes/hypertension, hepatic hydrothorax, and baseline serum creatinine/sodium.
• Mortality at 12 months and MELD-Na score at 90 days were secondary outcomes.

Conclusions:

• Transjugular intrahepatic portosystemic shunt (TIPS) placement can be safe in selected older patients.
• Age alone should not be an absolute contraindication for TIPS.
• Individualized discussion of risks and benefits is crucial for older patients considering TIPS.