Angelo Luca MD, Abstract Co-Author: Nothing to Disclose

Roberto Miraglia MD, Abstract Co-Author: Nothing to Disclose

Luigi Maruzzelli MD, Presenter: Nothing to Disclose

Giovanni Vizzini, Abstract Co-Author: Nothing to Disclose

Mario D'Amico MS, Abstract Co-Author: Nothing to Disclose

Fabio Tuzzolino, Abstract Co-Author: Nothing to Disclose

To evaluate incidence, outcome and prognostic factors of early liver failure (LF) after TIPS in cirrhotic patients with relatively preserved liver function.

We retrospectively reviewed 217 consecutive cirrhotic patients with baseline MELD ≤12 who underwent TIPS for portal hypertensive complications. TIPS indications were recurrent variceal bleeding (47.9%), refractory/recurrent ascites (41.5%), other (10.6%). Early LF defined as presence of death, liver transplantation (LT) or MELD >18 within 3-months after TIPS was assessed. The Kaplan-Meier method and the Log-rank test were used to look for predictors of early LF. Independent predictors were assessed using a multivariate Cox proportional hazards model.

Twenty (9.2%) out of 217 patients developed early LF after TIPS (10 patients died, 1 patient required LT and 9 patients increased the MELD to more than 18). In the latter group, two patients died at 6 and 9,8 months, two underwent LT at 7.8 and 11.9 months, 4 patients decreased the MELD≤12 from 4.3 to 12 months after TIPS and one patient maintained a stable MELD. One patient had bi-segmental hepatic necrosis on computed tomography; no other procedure-related technical complications were associated with early LF. Early LF was associated with significantly lower transplant free survival 97% vs. 40% at 6-months (p< 0.05) and 88% vs. 24% at 12-months (p< 0.0001) compared with patients without LF. Multivariate analysis revealed that refractory ascites (OR 4.6; CI 1.37-15.5; p=0.01) and pre-TIPS MELD ≥11 (OR 3.2; CI 1.07-9.5; p=0.01) were independently associated with the risk of early LF. In the subgroup of 95 patients with refractory ascites early LF occurred in 15 patients (16%), multivariate analysis disclosed that platelets level (OR 0.9; CI 0.99-0.99; p=0.01) was an additional independent predictors of early LF.

Early LF is not uncommon in cirrhotic patients with MELD≤12 undergoing TIPS especially in patients with refractory ascites and those with MELD ≥11. In the subgroup of patients with refractory ascites, platelet count was identified as additional prognostic factor. In more than two third of cases early LF causes death or requires LT.

Early LF is not uncommon in cirrhotic patients with MELD≤12 undergoing TIPS especially in patients with refractory ascites and those with MELD ≥11.

Luca, A, Miraglia, R, Maruzzelli, L, Vizzini, G, D'Amico, M, Tuzzolino, F, Early, Unexpected, Liver Failure after TIPS Placement in Cirrhotic Patients with Relatively Preserved Liver Function (MELD ≤12): Incidence, Outcome and Prognostic Factors.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013080.html