107 - Post TIPS Transplant Rate: A 10-Year Retrospective Analysis at a Tertiary Referral Hospital Unaffiliated with a Transplant Center

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Poster Presenter(s)

YL

Yifan Li, MS

Medical Student
Virginia Tech Carilion School of Medicine, United States

Author/Co-author(s)

MV

Matthew Vinson, BA

Medical Student
Virginia Tech Carilion School of Medicine, United States
AJ

Aakash Jain, MD

Resident
Lexington Medical Center, United States
TB

Thomas Bishop, MD

Chief of Interventional Radiology
Carilion Clinic, United States
ST

Sarah Thomas, MD

Chief of Interventional Radiology
Carilion New River Valley Medical Center, United States
JH

Joseph Hughes, MD

Vice Chair, Department of Radiology
Carilion Clinic, United States

Purpose: Advanced liver disease, stemming from multiple etiologies, can progress to cirrhosis, necessitating orthotopic liver transplantation (OLT) as the primary treatment. Transjugular intrahepatic portosystemic shunt (TIPS) serves as a bridging therapy for patients waiting for OLT by alleviating symptoms.However, the frequency of OLT following TIPS remains understudied, particularly in institutions lacking a transplant program, which this study aims to address.

Materials and Methods: This retrospective cohort study examined the prevalence of OLT among cirrhotic patients following TIPS at a tertiary referral hospital in southwest Virginia. Data from 188 patients between 2012 and 2022 were analyzed. Variables included indications for TIPS, etiology of cirrhosis, TIPS acuity, pre- and post-TIPS biomarkers, transplant-related information, and mortality rates. Statistical analyses, including ANOVA and T-tests, were conducted to assess clinical variables.

Results: Of the 188 patients, 11 (5.9%) underwent OLT post-TIPS, 39 (20.7%) were evaluated for OLT but didn’t receive one, and 138 (73.4%) were never evaluated for transplant. Factors contributing to low OLT rates included absolute or relative contraindications to OLT (28.6%), such as age and comorbidities, patient loss to follow-up (22.9%), and low MELD scores (18.6% ). Our cohort average MELD score is 15.5 ± 6.3. Mortality rates, excluding patients lost to follow-up, at 30 days was 26.9% (39/145) and at 6 months was 38.6% (56/145). The top etiology for cirrhosis was alcohol abuse (42.0%), followed by non-alcohol related fatty liver disease (33.5%) and hepatitis C (21.8%).

Conclusion: This study showed the low rate of liver transplantation post-TIPS placement in our patient cohort, potentially influenced by factors like loss to follow-up, patient ineligibility, and limited access to transplant services. Additionally, the relatively low MELD scores within the cohort suggest a lower likelihood of transplant evaluation and listing. Access to transplant services and social determinants of health, such as socioeconomic status and education level, play pivotal roles in OLT utilization for cirrhotic patients undergoing TIPS, especially in institutions without affiliated transplant centers. Comparative research across institutions, refining transplant evaluation criteria, and addressing disparities in access to care are imperative for optimizing outcomes in this patient population.