Survival Outcomes of Salvage TIPS in High-risk Patients

Wednesday, April 2, 2025

11:51 AM – 12:00 PM CT

Location: Music City Center, 208 AB

Presenting Author(s)

Yasaman Rahimi, MD (she/her/hers)

postdoc fellow
University of Maryland school of Medicine, United States

Author/Co-author(s)

SP

Sandhya Patel, MD

Resident
University of Maryland Medical Center, United States
ah

alina hasanian, MD

resident
university of maryland medical center, United States
AM

Ahmad Munir, DO

Radiology Resident
University of Maryland Medical Center, United States
GS

George Sidrak, MD

IR/DR PGY3 Resident
Univ of Maryland, United States
OI

Obi Ihim, MD

Fellow
1990, United States
YZ

Yuanlong Zhao, MD

Fellow
University of Maryland Medical Center, United States
VE

Vahid Etezadi, MD

faculty
University of Maryland School of Medicine, United States
KS

Kirti Shetty, MD

faculty
Georgetown University Hosptial, United States
Kevin Kim, MD

Professor
University of Maryland School of Medicine, United States
AF

Adam Fang, M.D.

Assistant Professor
University of Maryland Medical System, United States

Purpose: To evaluate survival outcomes of salvage transjugular intrahepatic portosystemic shunt (TIPS) in high-risk patients with profuse and persistent bleeding, despite endoscopic ligation and maximal medical treatments

Materials and Methods: 80 consecutive high-risk patients (Child C, MELD 3.0 ≥ 18) treated with salvage TIPS over a 10-year period at the tertiary medical center. A chi-square test was employed to assess differences between categorical variables, and a t-test was utilized for continuous variables. Survival analysis was conducted using the Kaplan-Meier method, and survival curves were compared with the log-rank test. Multivariate analysis by cox proportional hazards method was performed to identify survival predictors.

Results: Analysis on 80 consecutive high-risk patients treated with salvage TIPS performed (M:F 82.5%:17.5%, with a mean age of 52 years ± 12). The mean pre- and post-salvage TIPS portosystemic gradients were 21.8 ± 6.3 mmHg and 9.9 ± 4 mmHg, respectively (P < 0.001). Of the 80 patients, 48 (60%) achieved clinical stability after salvage TIPS and survived to discharge. No deaths were attributable to the procedure. No recurrent bleeding within the 1st month achieved in 67.5%. The short-term survival rates at 30 and 90 days were 57.25% and 52%. The pre-salvage TIPS MELD 3.0 score (HR 2.1; 95% CI 1.5 – 3.9; P < 0.001) and 10-day survival following salvage TIPS with absence of recurrent bleeding within the 1st month (HR 8.7; 95% CI 3.4 – 21.8; P < 0.001) were significant and independent predictors of overall survival. Pre-salvage TIPS creatinine and total bilirubin levels were associated with a positive hazard coefficient (1.14 and 1, respectively), suggesting an increased risk to overall survival.

Conclusion:

The in-hospital survival rate among high-risk patients (Child C, MELD 3.0 ≥ 18) with profuse and persistent bleeding, despite endoscopic ligation and maximal medical treatments was 60%. The pre-salvage TIPS MELD 3.0 and 10-day survival post-salvage TIPS with obliteration of recurrent variceal bleeding within 30 days were significant and independent predictors of overall survival.