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TIPS in Older Adults: Reserve-Based Risk Stratification and Practical Approach
Yi He1,2, Yuanyuan Li1,2, Langli Gao1,2
1Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610207, China.
Journal of Clinical Medicine
|May 4, 2026
Summary
Chronological age is not a barrier for transjugular intrahepatic portosystemic shunt (TIPS) procedures. A new pathway assesses multiple physiological domains to optimize outcomes and reduce complications in older adults undergoing TIPS.
Area of Science:
- Hepatology
- Interventional Radiology
- Geriatric Medicine
Background:
- Transjugular intrahepatic portosystemic shunt (TIPS) is crucial for managing portal hypertension complications.
- Older adults with cirrhosis present unique challenges for TIPS eligibility and safety.
Purpose of the Study:
- To review evidence on TIPS safety and outcomes in older adults.
- To propose an elderly-focused clinical pathway for optimizing TIPS in this population.
Main Methods:
- Review of observational cohorts, registry analyses, and systematic reviews/meta-analyses.
- Development of a four-domain assessment (Liver-Brain-Body-Heart/Kidney) and risk tiering system.
Main Results:
- Advanced age is linked to increased risks of hepatic encephalopathy, mortality, and readmissions post-TIPS.
- A structured, multidomain assessment is superior to chronological age alone for patient selection.
Conclusions:
- TIPS can be safely performed in older adults by shifting from age-based to a comprehensive physiological reserve assessment.
- The proposed pathway guides patient selection, procedural planning, and post-procedure care to improve outcomes and quality of life.
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