P- 63 UTILITY OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT IN TREATING COMPLICATIONS OF PORTAL HYPERTENSION: EXPERIENCE IN UNIT OF LIVER TRANSPLANTATION IN URUGUAY

Introduction and Objectives

Trans jugular intrahepatic portosystemic shunt (TIPS) is the major therapeutic alternative for treating portal hypertension-related complications (PHT) that do not respond to medical treatment. It is commonly used as a bridge therapy to liver transplantation (LT). TIPS improves quality of life, overall survival, and LT-free survival while reducing the incidence of decompensation. Adequate patient selection is crucial for rightful indication. This study aimed to present the utility of TIPS on the complications of refractory PHT that don´t respond to standard of care medical treatment.

Materials and Methods

From July 2017 to December 2022, all consecutive patients with PHT admitted to receiving TIPS creation were retrospectively analyzed. The objective was to decrease the portal pressure gradient below 12 mmHg or >50% of its baseline. Follow-up was performed using Doppler ultrasound to monitor permeability and function.

Results

264 patients were evaluated for LT, of whom 15 had complications of refractory PHT that did not respond to medical treatment (Table1). Nine were females and six males. Mean age of 47 years old. Eight (53%) had refractory ascites, and seven (47%) had recurrent variceal bleeding. The median follow-up period was 38 (1-66) months. Success was assessed based on hemodynamic, clinical, and imaging parameters. All patients had favorable outcomes, with transient hepatic encephalopathy observed in 3 cases and hemolytic anemia in one case. Global dysfunction occurred in 20% of patients at one year but was corrected through stent angioplasty. Four patients underwent transplantation, and eight were removed from list due to clinical improvement. Two patients died, and one is currently on the waiting list. Overall survival rates were 93% at one year and 87% at three years.

Conclusions

TIPS is a highly useful therapeutic tool which is applied in our center. Proper patient selection allows for similar overall and transplant- free survival rates as reported internationally.