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

Abstract

Background and Aims: Frailty 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. Methods: We 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. Results: Median 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. Conclusions: TIPS 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 Registration: ClinicalTrials.gov identifier: NCT05466669 and NCT04801290.