Impact of Frailty on the Prognosis of Patients With Liver Cirrhosis Undergoing Insertion of a TIPS

Background and AimsFrailty is associated with a poorer prognosis of patients awaiting liver transplantation. Data on the impact of frailty on prognosis after transjugular intrahepatic portosystemic shunt (TIPS)‐insertion in patients with cirrhosis and the influence of TIPS on longitudinal changes in frailty are lacking.MethodsWe retrospectively analysed data of 123 prospectively recruited patients with cirrhosis in Mainz and Hannover prior to elective TIPS insertion and monitored them for death/liver transplantation or post‐TIPS overt hepatic encephalopathy (OHE). Patients underwent testing with the Liver Frailty Index (LFI) prior to TIPS insertion as well as 1, 3 and 6 months after TIPS placement.ResultsMedian LFI prior to TIPS insertion was 4.32 (interquartile range: 3.78–4.88). 53% of patients who were frail at baseline and still alive at 6 months improved to prefrail status within 6 months of TIPS insertion. Higher LFI and younger age were associated with a decrease in LFI within 6 months. During follow‐up, 40 patients developed post‐TIPS OHE and 30 patients died or received a liver transplantation. There was no significant association between LFI as a metric variable and post‐TIPS OHE or liver transplantation/death. However, patients with LFI values in the lowest quartile had a significantly better transplantation‐free survival.ConclusionsTIPS insertion seems to improve physical functioning, as indicated by a decreasing LFI, but only in patients with a poor performance in LFI prior to TIPS. Conducting LFI prior to elective TIPS insertion can identify those with an excellent prognosis. However, frailty should not be considered a contraindication for TIPS.Trial RegistrationClinicalTrials.gov identifier: NCT05466669 and NCT04801290