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.

Keywords

• liver
• encephalopathy
• ascites
• varices
• stent