Abstract
<title>Abstract</title> <p> Introduction: Transjugular intrahepatic portosystemic shunt (TIPS) is an established therapy for portal hypertension complications, including refractory ascites and variceal bleeding. AASLD guidelines recommend TIPS in appropriately selected individuals; however, no age-specific threshold exists. As a result, uncertainty remains regarding whether elderly adults experience worse outcomes after TIPS. This study evaluated whether adults ≥ 70 years undergoing TIPS experienced differences in mortality or clinical outcomes compared with younger patients. Methods: We conducted a single-center retrospective analysis of 319 patients who underwent TIPS, stratified into patients < 70 years (n = 292) and ≥ 70 years (m = 27). Demographic and clinical characteristics including TIPS indication are summarized descriptively in <italic>table 1</italic> . Primary outcomes were 1-year mortality and the number of hepatic encephalopathy (HE) admissions within 1 year. Secondary outcomes included 90-day emergency department (ED) visits or admissions, discharge on lactulose, intraprocedural mortality and shunt caliber. HE admissions, ED visits, and shunt caliber were categorized into clinically relevant strata. Group comparisons used Pearson’s Chi-square or Fisher-s exact tests with two-sided α = 0.05. Results: Patients ≥ 70 years had higher rates of hypertension (66.7% vs. 34.2%) and coronary artery disease (29.6% vs. 14.4%). The most common TIPS indications were refractory acute variceal bleeding and refractory ascites/hydrothorax comprising nearly 80% of cases in both groups. One-year mortality was significantly higher in patients ≥ 70 (48.1% vs. 24.3%, p = 0.007). HE admissions within 1 year did not differ by age (p = 0.38). There were no significant differences in 90-day ED visits or hospitalizations (p = 0.33), discharge on lactulose (70.7% vs 71.4%, p = 0.95), or shunt caliber selection (6–8 mm vs 9–14 mm, p = 0.58). Peri-procedural mortality was similar between groups (14.0% vs 18.5%, p = 0.57). Most in-hospital deaths occurred in patients with acute refractory variceal bleeding (73.8% of deaths), particularly among those under 70 (78% vs 40%). Conclusion: In this single center cohort, patients ≥ 70 years who underwent TIPS had significantly higher 1-year mortality compared with younger patients, while short-term outcomes, including HE and hospital utilization, were comparable. These findings suggest that advanced age alone should not preclude TIPS but may signal increased long-term mortality risk. Clinical decision-making should remain individualized, and future prospective studies incorporating frailty and comorbidity indices are needed to better define TIPS candidacy in older adults. </p>