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

Background and Aims: Patients experience more complications of portal hypertension as liver disease progresses, many of which can be managed by transjugular intrahepatic portosystemic shunt (TIPS) insertion. Controversy surrounds the association of age with TIPS-related complications. We sought to evaluate the effect of age on TIPS-associated outcomes, including hospital admissions. Methods: This retrospective, bicentric cohort study included patients who underwent TIPS insertion between January 1, 2006, and December 31, 2016. The primary outcome of the study was predictors of liver-related hospital admission within 12 months of TIPS insertion between patients < 70 years and ≥ 70 years old. Secondary outcomes included mortality at 12 months and MELD-Na score at 90 days following TIPS placement. Results: A total of 593 patients were included in the study-487 patients were less than 70 years old while 106 patients were 70 years of age or older. Near equal percentages of elderly and nonelderly patients were admitted with post-TIPS complications within 12 months of insertion (29.2% v. 29.0%, p=0.91). Pre-existing diagnoses of diabetes and/or hypertension, hepatic hydrothorax, as well as serum creatinine and/or serum sodium at the time of TIPS insertion were associated with TIPS-related admissions within the first 12 months of shunt insertion. Conclusion: TIPS placement in selected older patients can be safe. Age should not be a strict contraindication for TIPS insertion, but discussion regarding risks and benefits of the procedure should be individualized.