Abstract No. 283 Technical and Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt for the Management of Portal Hypertension Complications in Patients with Cancer

Although the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for managing portal hypertension is well established, the outcomes of performing TIPS in patients with cancer are poorly understood. We assessed the safety and efficacy of TIPS in patients with cancer. A single-center retrospective study was performed in a large referral center from September 2016 to June 2023 on patients with cancer who underwent TIPS procedure. The Child-Pugh (C-P) classification, INR (International Normalized Ratio), serum bilirubin, and creatinine before TIPS and 1 month after TIPS, along with the patient's response and overall survival data were collected, as well as the incidence of hepatic encephalopathy (HE) after TIPS. Forty-one consecutive patients with cancer who underwent TIPS (mean age SD of 60.7 12.2 and a male-to-female ratio of 30:11) were included. The technical success rate was 100%. There were no major immediate procedure-related complications. The primary indications for TIPS placement were ascites in 18(43.9%), gastrointestinal bleed in 20(48.8%) and hydrothorax in 3(7.3%). The median (range) MELD score pre-TIPS was 11.5 (6.5-20.1). C-P scoring before TIPS yielded 4 (9.8%), 34 (82.9%), and 3 (7.3%) cases in classes A, B, and C, respectively. The 1-, 3- and 6-month mortality rates were 9.8%, 26.8%, and 46.3%, respectively. The median OS (range) was 14.9(0.03-61) months and significantly differed by C-P classes (P< 0.001). No significant correlations existed between OS and the MELD score or pre-TIPS lab data. 14 patients developed HE (32.2%) post-TIPS and only one case (2.4%) required shunt reduction. One month after TIPS, 15(36.6%) of cases were responsive, 17(41.5%) were semi-responsive, and 9(22%) had no response. These responders and non-responders significantly differed in OS (P< 0.001). In addition, 26 cases (63.4%) had unchanged C/P classification, while 6(15.1%) and 5(12.2%) had C-P worsening and improvement, respectively. These findings confirm the safety and efficacy of TIPS to manage portal hypertension complications in patients with cancer, with a high clinical and technical success rate, and suggest better overall survival for patients who respond to TIPS compared to non-responders.