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Age-related Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunts

Suraweera, Duminda MD; Jimenez, Melissa BS; Viramontes, Matthew BS; Jamal, Naadir; Grotts, Jonathan MA; Elashoff, David PhD; Lee, Edward W. MD; Saab, Sammy MD, MPH, AGAF, FAASLD

Journal of Clinical Gastroenterology: April 2017 - Volume 51 - Issue 4 - p 360–363
doi: 10.1097/MCG.0000000000000541
LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Aim: To compare age-related morbidity and mortality after transjugular intrahepatic portosystemic shunts (TIPS).

Methods: We performed a retrospective chart review of patients who underwent TIPS at the University of California Los Angeles Medical Center between 2008 to 2014. Elderly patients (65 y and older) were matched with nonelderly patients (controls, below 65 y) by model for end-stage liver disease (MELD) score (±3), indication for TIPS (refractory ascites vs. variceal bleeding), serum sodium level (±5), in a ratio of 1:1. Endpoints measures were hospital stay post-TIPS, rifaximin, or lactulose use, TIPS failure at 30 days, readmission at 90 days, MELD at 90 days, and mortality at 90 days.

Results: A total of 30 patient matches were included in this study: 30 control and 30 elderly patients. The median [interquartile (IQR)] MELD scores for controls and elderly were 11 (9, 13.8) for the controls and 11.5 (9, 14.8) for elderly patients (P=0.139). There were no significant differences in serum sodium and indication for TIPS. Thirty and 90-day follow-up laboratory test results were also similar between elderly and control patients. Event-free survival at 90 days was similar between controls and elderly patients [odds ratio (OR), 0.86; 95% confidence interval (CI), 0.3-2.5; P>0.05]. There was a trend toward greater hospitalization (OR, 1.76; 95% CI, 0.52-5.95; P=0.546) and mortality (OR, 3.3; 95% CI, 0.3-14.01; P=0.182).

Conclusions: The results of this study suggest event-free survival is similar between nonelderly and elderly patients. Although statistically significant, there is a tendency toward greater mortality and hospitalization in the elderly.

*Department of Medicine, Olive-View Medical Center, Sylmar

Departments of Surgery

§Biostatistics

Radiology

Medicine, University of California at Los Angeles, Los Angeles, CA

S.S., D.E., and E.W.L.: study concept and design. D.S., M.J., M.V. and N.J.: acquisition of data. D.S., M.J., J.G., D.E., and S.S.: analysis and interpretation of data. D.S., M.J., M.V., J.G., D.E. and S.S.: drafting of the manuscript. D.S., M.J., J.G., D.E. and S.S.: critical revision of the manuscript for important intellectual content. D.S., J.G. and D.E.: statistical analysis. D.E., E.W.L. and S.S.: administrative, technical, or material support; study supervision.

The authors declare that they have nothing to disclose.

Reprints: Sammy Saab, MD, MPH, AGAF, FAASLD, Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095 (e-mail: SSaab@mednet.ucla.edu).

Received January 6, 2016

Accepted April 3, 2016

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