P-79 CHARACTERISTICS AND OUTCOMES OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) RECIPIENTS IN A TERTIARY HOSPITAL. LIMA - PERU (JANUARY 2019 - MARCH 2024)

Conflict of interest

No

Introduction and Objectives

Portal Hypertension (PHT) is the determining event of decompensations in liver cirrhosis, increasing its mortality. TIPS is an effective strategy for the management of PHT; however, in Latin America there are few studies on this topic. Objective: To describe characteristics and results of TIPS recipients in a tertiary hospital in Lima (Peru) from January 2019 to March 2024.

Patients / Materials and Methods

This observational, retrospective and cross-sectional study reviewed all medical records of patients ≥ 18 years old undergoing TIPS between January 2019 and March 2024, performed by Interventional Radiology Service. For statistical analysis, SPSS 29 software was used.

Results and Discussion

A total of 43 patients (46,5% male) were included, with a mean age of 52.3 years (SD14.9), most of them cirrhotic (93%), being MASLD the main etiology (45%). The mean Child Pugh score was B9, and the Model for End-stage Liver Disease (MELD) score was 12.45 (SD4.6).

TIPS was mainly indicated for refractory/resistant ascites 39.5% (17/43) and variceal hemorrhage 27.9% (12/43), and there was more than one indication in 18.6% (8/43). The mean shunt diameter was 10mm with a pre-procedure pressure gradient of 23.5mmHg (range 12-40) and post-procedure pressure gradient of 7.44 (range 4-13).

Technical success was achieved in 95.3% (shunt creation), hemodynamic success (GHPVH < 12mmHg or decrease ≥50%) in 100% and favorable clinical success (Table 1).

It was found that 55.8% (24/43) had at least one complication, the main one being hepatic encephalopathy in 32.6% (14/43) and the most serious being hemoperitoneum in 9.3% (4/43).

The average follow-up time was 11 months (1–56 months), showing that 16.27% of patients had access to liver transplantation.

Conclusions

The main indication for TIPS in our setting was refractory ascites, followed by variceal hemorrhage, with high technical and hemodynamic success and favorable clinical response; the most common complication being hepatic encephalopathy.

TABLE 1: INDICATIONS AND CLINICAL SUCCESS OF TIPS

TIPS INDICATION (N = 43)	N	%
- VARICEAL HEMORRHAGE (VH)	12	27.9
- REFRACTORY / RESISTANT ASCITES	17	39.5
- HEPATIC HYDROTHORAX	2	4.7
- BUDD CHIARI SYNDROME	3	7.0
- PORTAL THROMBOSIS	1	2.3
- TWO OR MORE INDICATIONS	8	18.6
CLINICAL SUCCESS (N = 41) *
- CONTROL OF VH WITHOUT RECURRENCE	10/11	90.9
- ASCITES RESOLUTION ^a	2/24	8.3
- PARTIAL RESOLUTION OF ASCITES ^b	22/24	91.7
- PARTIAL RESOLUTION OF HYDROTHORAX ^c	4/4	100

*Patients who achieved technical and hemodynamic success were included in the analysis.

^aAscites controlled without paracentesis or diuretics.

^bAscites controlled without paracentesis with diuretics

^cHydrothorax controlled without thoracentesis with diuretics