Renal-function change after transjugular intra-hepatic portosystemic shunt placement and its relationship with survival: a single-center experience

Min Lang; Angela L Lang; Brian Q Tsui; Weiping Wang; Brian K Erly; Bo Shen; Baljendra Kapoor

doi:10.1093/gastro/goaa081

Renal-function change after transjugular intra-hepatic portosystemic shunt placement and its relationship with survival: a single-center experience

Gastroenterol Rep (Oxf). 2020 Dec 3;9(4):306-312. doi: 10.1093/gastro/goaa081. eCollection 2021 Aug.

Authors

Min Lang¹, Angela L Lang², Brian Q Tsui³, Weiping Wang⁴, Brian K Erly⁵, Bo Shen⁶, Baljendra Kapoor⁷

Affiliations

¹ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
² Department of Anesthesia, Critical Care, and Pain Management, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Radiology, UCLA Medical Center, Los Angeles, CA, USA.
⁴ Department of Radiology, Mayo Clinic, Jacksonville, FL, USA.
⁵ Colorado School of Public Health, Aurora, Colorado, USA.
⁶ The Inflammatory Bowel Disease Center at Columbia, Columbia University Irving Medical Center, New York, NY, USA.
⁷ Division of Vascular and Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.

Abstract

Background: The effect of transjugular intra-hepatic portosystemic shunt (TIPS) placement on renal function and the correlation of post-TIPS Cr with mortality remain unclear. This study aimed to assess the effect of TIPS placement on renal function and to examine the relationship between post-TIPS Cr and mortality risk.

Methods: A total of 593 patients who underwent de novo TIPS placement between 2004 and 2017 at a single institution were included in the study. The pre-TIPS Cr level (T0; within 7 days before TIPS placement) and post-TIPS Cr levels, at 1-2 days (T1), 5-12 days (T2), and 15-40 days (T3), were collected. Predictors of Cr change after TIPS placement and the 1-year mortality rate were analysed using multivariable linear-regression and Cox proportional-hazards models, respectively.

Results: Overall, 21.4% of patients (n = 127) had elevated baseline Cr (≥1.5 mg/dL; mean, 2.51 ± 1.49 mg/dL) and 78.6% (n = 466) had normal baseline Cr (<1.5 mg/dL; mean, 0.92 ± 0.26 mg/dL). Patients with elevated pre-TIPS Cr demonstrated a decrease in post-TIPS Cr (difference, -0.60 mg/dL), whereas patients with normal baseline Cr exhibited no change (difference, <0.01 mg/dL). The 30-day, 90-day, and 1-year mortality rates were 13%, 20%, and 32%, respectively. Variceal bleeding as a TIPS-placement indication (hazard ratio = 1.731; P = 0.036), higher T0 Cr (hazard ratio = 1.834; P = 0.012), and higher T3 Cr (hazard ratio = 3.524; P < 0.001) were associated with higher 1-year mortality risk.

Conclusion: TIPS placement improved renal function in patients with baseline renal dysfunction and the post-TIPS Cr level was a strong predictor of 1-year mortality risk.

Keywords: TIPS; mortality; portal hypertension; renal failure; renal function; transjugular intra-hepatic portosystemic shunt.