Background: TIPS is effective for treating complications of portal hypertension. Historic, single center data suggest poor outcomes for MELD scores >15. We assessed contemporary outcomes following TIPS among a multi-center, retrospective cohort of patients with cirrhosis across 9 centers. Kaplan-Meier with log rank test estimated survival across quartiles of MELD score. Patients were censored at date of death, transplantation, or last follow-up.

Results: TIPS recipients (n=1146) had a mean MELD score of 16 (SD 6.6) and median 15 (6.4-58.5). Indications were ascites (40%), variceal bleeding (31%), ascites+variceal bleeding (10%), hepatohydrothorax (6%), treatment of portal vein thrombosis (5%), & other (7%). Covered stents were used in 89%, revision was required in 31% and subsequent liver transplant in 21%. Transplant-free survival at 30, 90, & 365 days was 81%, 70%, 54% with mean survival of 2.7 yrs. MELD >20 was associated with worse 30 and 90-day survival (Figure 1a, p=0.003). After 90 days, the probability of survival was significantly improved for those with MELD scores less than 19 (Figure 1b, p<0.001).

Conclusion: Short term survival is excellent in a large US multicenter cohort of TIPS recipients with MELD <19. These findings challenge the historical MELD cutoff of 15 for undergoing TIPS.

CITATION INFORMATION: Boike J., Ge J., German M., Jest N., Morelli G., Spengler E., Said A., Lee A., Hristov A., Kolli K., Lai J., Desai A., Junna S., Pokhrel B., Couri T., Paul S., Christian-Miller N., Frenette C., Laurito M., Verna E., Rahim U., Goel A., Das A., Pine S., Gregory D., VanWagner L. Contemporary Practice Patterns & Outcomes after Transjugular Intrahepatic Portosystemic Shunt (TIPS) Placement: A Multicenter US Experience of 1,146 Patients Am J Transplant. 2017;17 (suppl 3).

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