Elective Transjugular Intrahepatic Portosystemic Shunt Creation in Cirrhosis Improves Body Composition and Function:...

Area of Science:

• Hepatology
• Gastroenterology
• Clinical Nutrition

Background:

• Sarcopenia and frailty significantly increase morbidity and mortality in patients with cirrhosis.
• Transjugular intrahepatic portosystemic shunt (TIPS) creation is used for refractory ascites, but its impact on muscle loss requires further investigation.
• Prospective evidence on TIPS and its effects on sarcopenia and frailty in cirrhosis is limited.

Purpose of the Study:

• To evaluate the effect of TIPS creation on body composition and physical function in cirrhotic patients.
• To assess whether TIPS can reverse muscle loss and improve frailty in individuals with cirrhosis.
• To compare outcomes between patients receiving standard of care (SOC) and those undergoing SOC + TIPS.

Main Methods:

• A single-center pilot randomized controlled trial involving 26 cirrhotic adults with portal hypertension complications.
• Participants were randomized to standard of care (SOC) or SOC + TIPS creation.
• Primary outcomes included CT-derived skeletal muscle index (SMI), psoas muscle index (PMI), adiposity, Short Physical Performance Battery, and Liver Frailty Index, assessed at baseline and 6 months.

Main Results:

• The TIPS group demonstrated significant increases in SMI and PMI, alongside improvements in adiposity indices.
• In contrast, the standard of care group showed no significant changes in body composition metrics.
• The TIPS cohort exhibited significant improvements in functional scores, with no increase in adverse events, hepatic encephalopathy, MELD scores, or survival compared to the SOC group.

Conclusions:

• TIPS creation shows promise in improving body composition, physical function, and quality of life in cirrhotic patients.
• The findings suggest TIPS may be a beneficial intervention for sarcopenia and frailty in this population.
• Larger randomized trials are warranted to confirm these preliminary findings and establish the role of TIPS in managing sarcopenia and frailty in cirrhosis.