Muscle Gain after Transjugular Intrahepatic Portosystemic Shunt Creation: Time Course and Prognostic Implications for Survival in Cirrhosis

Clinical question
Is transjugular intrahepatic portosystemic shunt (TIPS) placement associated with truncal muscle gain and potentially improved mortality?

Take-away point
TIPS resulted in truncal muscle gains, seen maximally at 6 months after shunt placement. At one year, muscle gain was independently associated with decreased mortality.

Reference
Jahangiri Y, et al. Muscle gain after transjugular intrahepatic portosystemic shunt creation: time course and prognostic implications for survival in cirrhosis. J Vasc Interv Radiol. 2019 Jun; 30(6): 866-872.

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Study design

Retrospective review

Funding source

None identified

Setting
University hospital setting – Oregon, United States.






Table 2

Comparison of Cross-Sectional Truncal Muscle Area and Attenuation by CT before and after TIPS at a Median 13.5 Months after TIPS

Summary

This is a retrospective review of a cohort of patients who underwent TIPS at a single institution over a 12 year period. Only patients with native livers who had pre and post CT imaging were included (N=76). The authors then evaluated core abdominal muscles in three regions: psoas, paraspinal, and abdominal wall musculature. Volumes as well as attenuation of these muscle groups were then calculated before and after TIPS. The authors found statistically significant gains in both volume and attenuation of the truncal musculature after TIPS, with maximal increase at approximately 6 months. These volume gains were also found on multivariate analysis to be associated with lower mortality.

Commentary

This retrospective study increases the body of literature regarding the association of core muscle mass with overall survival in cirrhotic patients. In addition, it also supports that TIPS creation may help, either directly or indirectly, allow patients to improve their muscle mass. The limitations of this article are its study design and relatively small number of patients. That said, statistical significant was achieved on multivariate analysis. The study also improves the knowledge regarding the time frame of the muscle gains in patients undergoing TIPS.

Post Author

Daniel P. Sheeran, MD
Assistant Professor
Department of Radiology and Medical Imaging
Division of Vascular and Interventional Radiology
University of Virginia