Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt

AIM: To evaluate and validate the national trends and predictors of in-patient mortality of transjugular intrahepatic portosystemic shunt (TIPS) in 15 years.METHODS: Using the National Inpatient Sample which is a part of Health Cost and Utilization Project, we identified a discharge-weighted national estimate of 83884 TIPS procedures performed in the United States from 1998 to 2012 using international classification of diseases-9 procedural code 39.1. The demographic, hospital and co-morbility data were analyzed using a multivariant analysis. Using multi-nominal logistic regression analysis, we determined predictive factors related to increases in-hospital mortality. Comorbidity measures are in accordance to the Comorbidity Software designed by the Agency for Healthcare Research and Quality.RESULTS: Overall, 12.3% of patients died during hospitalization with downward trend in-hospital mortality with the mean length of stay of 10.8 ± 13.1 d. Notable, African American patients (OR = 1.809 vs Caucasian patients, P < 0.001), transferred patients (OR = 1.347 vs non-transferred, P < 0.001), emergency admissions (OR = 3.032 vs elective cases, P < 0.001), patients in the Northeast region (OR = 1.449 vs West, P < 0.001) had significantly higher odds of in-hospital mortality. Number of diagnoses and number of procedures showed positive correlations with in-hospital death (OR = 1.249 per one increase in number of procedures). Patients diagnosed with acute respiratory failure (OR = 8.246), acute kidney failure (OR = 4.359), hepatic encephalopathy (OR = 2.217) and esophageal variceal bleeding (OR = 2.187) were at considerably higher odds of in-hospital death compared with ascites (OR = 0.136, P < 0.001). Comorbidity measures with the highest odds of in-hospital death were fluid and electrolyte disorders (OR = 2.823), coagulopathy (OR = 2.016), and lymphoma (OR = 1.842).CONCLUSION: The overall mortality of the TIPS procedure is steadily decreasing, though the length of stay has remained relatively constant. Specific patient ethnicity, location, transfer status, primary diagnosis and comorbidities correlate with increased odds of TIPS in-hospital death.

Curing Hepatitis C in Liver Transplant Recipients Is Associated with Changes in Immunosuppressant Use

Background and Aims:All-oral interlferon-free antivirals are highly effective in treating recurrent hepatitis C (HCV) infection in liver transplant (LT) recipients.The aim of the study was to assess immunosuppression needs after achieving a sustained viral response (SVR).Methods:We compared immunosuppression needs before and after achieving a SVR in adult LT recipients treated for recurrent HCV infection with alloral direct acting agents.Results:We identified 52 liver LT treated recipients who achieved a SVR.The median (25th and 75th percentile interquartile range [IQR]) age was 62 years (57.75,65).Most recipients received tacrolimus (TAC) for their immunosuppressant regimen.After achieving SVR,there was no statistically significant difference in daily dose of TAC unadjusted per weight (p > 0.05).However,there was a statistically significant decrease in daily dose of TAC adjusted per weight,serum levels of TAC,and the product of glomerular filtration rate and TAC.No statistically significant differences in cyclosporine unadjusted/adjusted per weight daily dose or serum levels were noted.Conclusions:Immunosuppression needs were increased for those patients treated with TAC but not cyclosporine.LT recipients prescribed TAC require close monitoring after treatment completion to avoid potential risk of acute rejection.

Clinical Food Addiction Is Not Associated with Development of Metabolic Complications in Liver Transplant Recipients

Background and Aims:Given the increased risk of posttransplant metabolic syndrome(PTMS;defined by hypertension,diabetes mellitus and hyperlipidemia),we aimed to identify the potential role of food addiction in the development of metabolic complications in the post-liver transplant population.Methods:Inclusion criteria included adult liver transplant recipients followed at our institution between June 2016 and November 2016.Participants were administered a demographic survey as well as the Yale Food Assessment Scale 2.0,a 35-item questionnaire used to assess frequency of food addiction in accordance with the DSM-V guidelines of substance use disorders.Demographic and clinical data were collected.Results:Our study included 236 liver transplant recipients(139 males,97 females).The median(interquartile range[IQR])BMI of participants was 26.8 kg/m2(24.2,30.4),and median(IQR)time since transplantation was 50.9 months(19.6,119.8).The prevalence rates of hypertension,hypercholesterolemia and diabetes mellitus were 54.7%,25.0%and 27.1%,respectively.Twelve participants(5.1%)were found to have a diagnosis of food addiction.A diagnosis of food misuse was made in 94(39.8%)of the transplant recipients.Conclusions:Our findings are consistent with prior data that indicate high prevalence of metabolic complications among liver transplant recipients.Food addiction was not predictive of metabolic complications within this population.Nevertheless,we found that this population was at high risk of demonstrating symptoms of food misuse,and they were not likely to appreciate the risks of pathologic patterns of eating.Given the increasing risk of cardiovascular morbidity and mortality in this population,efforts should be made to identify risk factors for the development of PTMS.