Outcomes After Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients 70 Years and Older

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is effective at treating ascites and variceal bleeding but may be associated with increased morbidity and mortality in older patients. Our aim was to report outcomes in patients 70 years and older who underwent TIPS because data are limited in this population. We performed a retrospective review of patients who underwent TIPS at our institution over 10 years. We matched those 70 years and older to those 50–59 years old by year of TIPS and the Model for End-Stage Liver Diseae-Sodium (MELD-Na). Thirty-day readmissions were higher in the elderly group (n = 50) compared to the younger group (n = 50), n = 17 (34%) and n = 6 (12%) (p = 0.02), respectively. Readmissions for post-TIPS hepatic encephalopathy (HE) in the older and younger groups were n = 14 (28%) and n = 5 (10%) (p = 0.04), respectively. Thirty-day mortality was higher in the older group compared to the younger group, but the difference was not statistically significant, 24% and 12%, respectively (p = 0.19). TIPS can be performed safely in patients 70 years and older, but the overall readmissions, and specifically for HE, were significantly higher in older patients. Patients 70 years and older should be followed closely after TIPS, and early introduction of treatment for encephalopathy should be considered.

Transjugular Intrahepatic Portosystemic Shunt Outcomes in the Elderly Population: A Systematic Review and Meta-Analysis

“…Six studies with a total of 1,591 patients met our inclusion criteria and were included in the final meta-analysis [28][29][30][31][32][33]. Three studies divided patients by age < 65 vs. > 65 years, with a total of 816 patients who were 54% male.…”

“…1) elaborates our systematic literature search process. Baseline characteristics, including patient demographics and indications for TIPS, are reported in Tables 2 and 3 [28][29][30][31][32][33]. Publication bias was not assessed due to the low number of studies.…”

“…Syed et al reported TIPS was a successful treatment for refractory complications of portal hypertension in elderly patients [ 34 ]. Adlakha and Russo reported a higher 30-day mortality rate in patients aged > 70 vs. < 70 years (24% vs. 12%), although the finding did not achieve statistical significance (P = 0.19) [ 32 ]. Similarly, in a retrospective review, Suraweera et al reported trends towards a higher 90-day mortality rate (OR: 3.3, 95% CI: 0.78 - 14.01, P = 0.182) and a higher 90-day hospitalization rate (OR: 1.76, 95% CI: 0.52 - 5.95, P = 0.546) in the elderly aged ≥ 65 years, although these also did not reach statistical significance [ 26 ].…”

“…MINORS was used to assess the quality of the studies (Table 1) [28][29][30][31][32][33]. Non-comparative studies were graded on eight MINORS criteria, with each item ranging from 0 to 2 (0 if not reported; 1 if reported but inadequate; 2 if reported and adequate), and a global score of 16 for non-comparative studies and 24 for comparative analyses considered ideal.…”

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

“…Another retrospective study in which the subjects were well matched for MELD score, indication for TIPS, and comorbidities showed that age is strongly and independently associated with 90-day post-TIPS mortality risk, particularly in those > 70 years[ 169 ]. Adlakha et al[ 170 ], in a retrospective study of 100 patients, similarly showed that re-admission rates and incidence of severe HE requiring hospital admission were higher in elderly patients, even after accounting for MELD score. They also found that TIPS for secondary prophylaxis of variceal bleeding, RA, and HH had acceptable morbidity and mortality.…”