S1068 The Impact of Renal Function on Hepatic Encephalopathy Following Transjugular Intrahepatic Portosystemic Shunt Placement for Refractory Ascites

Introduction: Refractory ascites is an important cause of morbidity and mortality in patients with advanced liver disease. However, the impact of renal function on clinical outcomes following transjugular intrahepatic portosystemic shunt (TIPS) placement for refractory ascites is poorly defined. We examined the role of renal function on hepatic encephalopathy (HE) following TIPS placement. Methods: A single center retrospective study was performed for all adult patients undergoing TIPS for refractory ascites from 2007-2019. Patients were stratified by GFR at time of TIPS based on cut offs of GFR < 30, 30-60, 60-90, and ≥ 90 ml/min/1.73 m2 with all patients on dialysis included in the GFR < 30 ml/min/1.73 m2 group. Patients were identified as having chronic kidney disease (CKD) stage 3 or higher if GFR was less than 60 ml/min/1.73 m2 for at least 3 months prior to TIPS. Logistic regression analyses were used to identify the role of GFR at time of TIPS, as well as the role of CKD on HE within 60 days post-TIPS. Results: Among 201 patients receiving TIPS for refractory ascites (61% male, mean age 59.1 ± 10.2 years, mean MELD score 17.3 ± 6.9) there were 78 (39%) patients that met the criteria for CKD based on 3-month pre-TIPS GFR values. Among these patients with CKD, 16 (21%) had hemodialysis-dependent renal failure. Mean GFR at time of TIPS was 62.7 ± 28.2 for all non-dialysis patients (n=185). GFR < 30 ml/min/1.73 m2 or dialysis at time of TIPS was found to be a significant predictor of post-TIPS HE within 60 days as compared to the GFR ≥ 90 ml/min/1.73 m2 group (OR, 3.56; 95%CI, 1.19-10.7; p=0.023). GFR between 30 and 60 ml/min/1.73 m2 and between 60 and 90 ml/min/1.73 m2 were not significant predictors for post-TIPS HE compared to the GFR ≥ 90 ml/min/1.73 m2 group. Stage 3 or higher CKD at time of TIPS was found to be a significant predictor for 60-day post-TIPS HE (OR, 2.52; 95%CI, 1.40-4.53; p=0.002). Conclusion: Among patients receiving TIPS for recurrent ascites, those with acutely impaired renal function as well as those with chronic renal dysfunction were found to have an increased risk for HE after TIPS. These results may inform evidence-based risk stratification for refractory ascites patients with impaired renal function, and highlights the need for further research on TIPS outcomes among patients with renal disease.Table 1.: Logistic Regression Analysis for Post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) Hepatic Encephalopathy (HE) by Glomerular Filtration Rate (GFR)