[A study on the efficacy and safety profile of transjugular intrahepatic portosystemic shunt received elderly patients with liver cirrhosis].

Abstract

Objective: To investigate the efficacy and safety profile of transjugular intrahepatic portosystemic shunt received by elderly patients with cirrhosis (age >75 years). Methods: A retrospective analysis was conducted on the data of patients who underwent TIPS for cirrhosis at Nanjing Drum Tower Hospital, affiliated with Nanjing University School of Medicine, from January 2019 to December 2021. Patients were divided into an elderly group (> 75 years) and a younger group (≤ 75 years) according to age. Propensity score matching was performed in a 1∶1 ratio. Statistical analysis was performed using the independent samples t-test, the Mann-Whitney U test, and the χ² test. Postoperative survival rate, rebleeding rate, and incidence rate of hepatic encephalopathy were analyzed using the Kaplan-Meier method between the two patient groups. Results: A total of 37 elderly and 478 younger cases were screened. Propensity score matching was performed in line with a 1∶1 ratio. Finally, 32 cases were included in each group. The elderly and younger patient groups had no statistically significant differences in the 1-year postoperative rebleeding rate [9.4% (3/32) vs. 6.3% (2/32), P=0.562], the incidence rate of hepatic encephalopathy [37.5% (12/32) vs. 18.8% (6/32), P=0.060], and the survival rate [25% (8/32) vs. 15.6% (5/32), P=0.371]. The incidence rate of hepatic encephalopathy according to the Child-Pugh class A stratification at 1 year following surgery had no statistically significant difference between the two patient groups' liver function [12.5% (1/8) vs. 11.1% (1/9), P=0.896]. However, the incidence rate of hepatic encephalopathy at 1 year following surgery with Child-Pugh class B and C had a statistically significant difference between the two patient groups' liver function [45.8% (11/24) vs. 21.7% (5/23), P=0.037]. Conclusion: Transjugular intrahepatic portosystemic shunt (TIPS) is equally safe and effective in elderly compared to younger patients. However, the incidence rate of postoperative hepatic encephalopathy is significantly higher in patients with Child-Pugh class B and C.