Date: Sunday, June 6, 2021
Session Time: 4:30pm-5:30pm
Presentation Time: 4:55pm-5:00pm
*Purpose: Data on the outcomes of patients with cirrhosis who require renal replacement therapy (RRT) at the time of transjugular intrahepatic portosystemic shunts (TIPS) is exceptionally limited. We aimed to describe the outcomes of this patient population.
*Methods: Adult patients with cirrhosis who underwent TIPS in the retrospective portion of the Advancing Liver Therapeutics Approaches (ALTA) Study from 2010-2015 were included. We grouped patients based on RRT status at TIPS, defined as ≥2 RRT encounters in the 28 days prior to TIPS. We calculated the relative risks of death and transplantation and used competing risk regressions (competing event = transplantation) to estimate the subhazard of death at 1-year.
*Results: Of 1,260 patients, 57 (4.5%) required RRT prior to TIPS. Of those 57, 60% (34) had RRT 2-28 days and 40% (23) had RRT within 2 days prior to TIPS. RRT patients had higher median MELD-Na (31 vs 17, p<0.01), INR (1.6 vs 1.5, p=0.04), bilirubin (2.8 vs 1.8mg/dL, p<0.01), and creatinine (2.4 vs 1.0mg/dL, p<0.01) at TIPS. RRT patients had a higher prevalence of heart failure (HF) at 19.3% vs 6.6% for the non-RRT group (p<0.01). At 1-year post-TIPS, the RRT group had substantially higher rates of death and transplant versus the non-RRT group at 51% vs 25% (p<0.01) and 19% vs 128% (p<0.01), respectively. The relative risks (RR) of death and transplantation for RRT vs. non-RTT groups were 2.7 (95%CI 2.04-3.57, p<0.01) and 2.1 (95%CI 1.29-3.36, p<0.01), respectively, at 1-year. Of those who died, median times to event were 11 days (IQR 3-32) in RRT and 42 days (IQR 13-134) in non-RRT patients. Adjusted (for age, bilirubin, INR, and HF) competing risk regression showed a subhazard ratio of 2.56 (95%CI 1.47-4.46) for death in RRT compared to non-RRT patients.
*Conclusions: In one of the largest studies of patients who require RRT at the time of TIPS, we found RR of death in RRT patients was 2.7 times that of non-RRT patients. Death occurred rapidly at median of 11 days. More investigation is required to determine whether the increased risk of mortality experienced by end-stage liver disease patients who require RRT is due to the TIPS procedure or an artifact of a higher baseline mortality rate.
To cite this abstract in AMA style:Ge J, Boike J, German M, Morelli GJ, Spengler E, Said A, Lee AS, Hristov A, Desai A, Couri T, Paul S, Frenette C, Christian-Miller N, Laurito M, Verna E, Rahim U, Goel A, Gregory D, VanWagner L, Kolli KP, Lai J. Outcomes of Transjugular Intrahepatic Portosystemic Shunts (TIPS) in Dialysis-Dependent ESLD Patients: The ALTA Study [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-transjugular-intrahepatic-portosystemic-shunts-tips-in-dialysis-dependent-esld-patients-the-alta-study/. Accessed June 16, 2021.
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