World Congress at ACG2017

Simultaneous Plenary Session 4A: Liver

56 - Changes in Kidney Function and Model for End-Stage Liver Disease Score in Diabetic Patients Undergoing the Transjugular Intrahepatic Portosystemic Shunt Procedure

Wednesday, October 18
9:00 AM - 9:10 AM
Location: Valencia Ballroom BC (Level 4)



Category: Liver       

Sherwin Chiu, BS1, Khalid Mahmoud, MD2, Mohamed Shoreibah, MD2, Sherif Moawad, MD, MSc2, Moustafa Massoud, MD2, Steve Kim, BS1, Nathan Ertel, MD2, Rachel Oser, MD2, Souheil Saddekni, MD, FSIR, FAHA2, Andrew Gunn, MD2, Omar Massoud, MD, PhD, FACG2, Basant Hamed, MD2, Ahmed Kamel Abdel Al, MD, MSc, PhD2
1University of Alabama at Birmingham School of Medicine, Birmingham, AL; 2University of Alabama at Birmingham, Birmingham, AL
Introduction: Diabetes is an important comorbidity present in up to 30% of patients with liver cirrhosis. The purpose of our study was to determine the impact of diabetes on the renal function and survival after transjugular intrahepatic portosystemic shunt (TIPS) procedure.

Methods: We reviewed the medical records of 387 patients who had successful TIPS between September 2004 and September 2016. The patients were divided into two groups; group A (diabetics, n=186) and group B (non-diabetics, n=201). The glomerular filtration rate (GFR) and model for end-stage liver disease (MELD) score before and within 1 month after TIPS placement was recorded in each group. A threshold GFR and MELD score associated with mortality was estimated in each group.

Results: The study included 261 (62%) males, 373 (88%) Caucasians, and 186 (45%) diabetics, with an average age of 59 (SD=9.7) for diabetics and 54.7 (SD=9.6) for non-diabetics. There was a statistically significant difference between diabetics and non-diabetics in mean GFR (63.3 versus 80.9 respectively, p < 0.0001) and in MELD score (13.3 versus 12.3 respectively, p=0.0123) before TIPS placement. In spite of the significant change in MELD score after TIPS placement in diabetics (p < 0.0001) and non-diabetics (p < 0.0001), there was no significant change in the GFR after TIPS placement in either diabetics (p=0.3345) or non-diabetics (p=0.5065). Lower pre-TIPS GFR was significantly associated with mortality in diabetics [HR=0.989, 95% CI (0.98-0.99), p=0.039), while higher pre-TIPS MELD score was associated with mortality in both diabetics [HR=1.07, 95% CI (1.00-1.14), p=0.0398] and non-diabetics [HR=1.08, 95% CI (1.03-1.14, p=0.001). The threshold of pre-TIPS GFR and MELD score in discriminating survival in diabetics was 54 (p=0.039) and 12 (p=0.0398). Non-diabetic status was a significant contributor to survival [HR=0.74, 95% CI (0.55-0.99), p=0.043].

Discussion: TIPS does not significantly change the GFR in diabetics. However, pre-TIPS lower GFR and higher MELD score were associated with mortality after TIPS in diabetic patients. The best survival outcome was seen in patients with GFR > 54 and MELD < 12, and the absence of diabetes was a significant contributor to survival in cirrhotic patients undergoing TIPS.

Supported by Industry Grant: No


Change in GFR and MELD in Diabetics





















  Pre-TIPS Post-TIPS p-value
GFR 63.28 (2.32) 64.37 (2.43) 0.3345
MELD 13.21 (0.43) 16.67 (0.58) <0.0001

Change in GFR and MELD in Non-diabetics





















  Pre-TIPS Post-TIPS p-value
GFR 80.85 (2.26) 81.64  (2.43) 0.5065
MELD 12.28 (0.45) 15.91 (0.58) <0.0001

Survival outcomes of diabetics versus non-diabetics

Citation: . CHANGES IN KIDNEY FUNCTION AND MODEL FOR END-STAGE LIVER DISEASE SCORE IN DIABETIC PATIENTS UNDERGOING THE TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT PROCEDURE. Program No. 56. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

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