Purpose: Transjugular intrahepatic portosystemic shunts (TIPS) have been established as first line therapy for cirrhotic patients with medically refractory ascites. A common underlying etiology of cirrhosis is alcohol abuse and some believe that refractory ascites, which is uncomfortable for patients, leads to bowel edema, and frequently requires drainage, serves as a kind of deterrent to substance abuse relapse for patients. This raises the question of whether relapse may be prevalent following TIPS, particularly in those patients who have no further ascites.
Material and Methods: After internal review board approval, 343 patients who had TIPS placed between 2006 and 11/1/2019, at a single-center; were retrospective reviewed. Of these 131 patients had cirrhosis due to alcohol abuse and a TIPS placed primarily for refractory ascites, 9 were excluded as they were lost to follow up, leaving 122 patients as the subject of this study. Length of sobriety and maintained sobriety at 1, 3, and 6-12 months after TIPS placement, as self-reported by the patient was recorded. Ascitic response to TIPS at 1, 3, and 6 months was also recorded; a significant reduction in ascitic burden was defined as at last a 50% reduction in the need for paracentesis.
Results: The cohort included 92 men (75.4%) and 30 women (24.6%) with an average age of 54.8 ± 9.2 years. 1.6% (2/122) of patients had relapsed at 1 month; there was no difference in ascites reduction in those who did (2/2, 100%) and those who did not (76/100, 76%) relapse (p=1). 4.1% (5/122) of patients had relapsed at 3 months; there was no difference in ascites reduction between those who did (11/15, 73.3%) and those who did not (83/96, 86.5%) relapse (p=0.24). 17.8% (19/107) of patients had relapsed by 1 year; there was no difference in significant ascites reduction in those who did (13/16, 81.3%) and those who did not relapse (81/90, 90%) (p=0.39). The mean time of sobriety at the time of TIPS placement for those who relapsed by 12 months was significantly less than those who did not relapse (289.8 ± 106.9 vs 791.4 ± 915.7, p=0.03). If looking at those sober for less than 1 year at time of TIPS, they were significantly more likely to relapse by 12 months than those who had been sober for greater than 1 year (p=0.01).
Conclusions: Relapse of alcohol abuse is a frequent issue for patients following TIPS placement; those who have been sober for short periods of time prior to TIPS may be at increased risk.