Original article
Pancreas, biliary tract, and liver
Association Between Transjugular Intrahepatic Portosystemic Shunt and Survival in Patients With Cirrhosis

https://doi.org/10.1016/j.cgh.2015.06.042Get rights and content

Background & Aims

A transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of refractory ascites and variceal bleeding. However, it is unclear whether a TIPS affects long-term survival. We investigated whether a TIPS is associated with survival in patients with cirrhosis awaiting liver transplantation.

Methods

By using the United Network for Organ Sharing registries from 2002 to 2013, we followed up a cohort of transplant-naive adults with cirrhosis (N = 97,063) from the time of transplant listing until the time of death or transplantation. We used Cox proportional hazards and competing-risks analyses to compare these primary outcomes between patients with a TIPS (n = 7475; 7.7%) and without a TIPS (n = 89,588; 92.3%) at the time of listing, adjusting for baseline characteristics.

Results

During an average follow-up period of 1.61 years, 23,305 (24%) patients died before undergoing transplantation, 47,563 (49%) underwent transplantation, and the remaining 26,195 (27%) still were alive without having received a liver transplant. Compared with patients without a TIPS, patients with a TIPS had a lower risk of death (adjusted subhazard ratio, 0.95; 95% confidence interval, 0.9–0.99), transplantation (adjusted subhazard ratio, 0.92, 95% confidence interval, 0.88–0.95), or the combined outcome of death or transplantation (adjusted hazard ratio, 0.85; 95% confidence interval, 0.83–0.88).

Conclusions

Among patients with cirrhosis awaiting liver transplantation, patients with a TIPS had a lower mortality rate than patients without a TIPS.

Section snippets

Study Data

Transplant centers and organ procurement organizations in the United States are required to submit standardized data collection forms to UNOS.13 These include patient information at the time of listing for liver transplantation and information collected during the time on the waiting list. We received a data file from UNOS that included information on all patients listed for liver transplantation in the United States between February 27, 2002 (the initiation date for the model for end-stage

Results

At the time of listing, patients with and without a TIPS were similar with regard to age, sex, serum sodium level, body mass index, and blood group. Compared with patients without a TIPS, patients with a TIPS were more likely to have diabetes, ascites, encephalopathy, and portal vein thrombosis, and less likely to be African American or to have HCC or HCV infection (Table 1). In addition, patients with a TIPS had a higher MELD score and a lower albumin level than patients without TIPS.

During an

Discussion

Our findings show that among patients with cirrhosis listed for liver transplantation, patients with a TIPS had a lower mortality rate than patients without a TIPS. Patients with a TIPS also had a lower risk of transplantation and of the combined outcome of death or transplantation.

The known benefits of TIPS arise from its ability to reduce portal venous pressure. TIPS not only prevents recurrent esophageal and gastric variceal bleeding,1, 2, 3 but also helps relieve medically refractory

Acknowledgments

This research was based on data derived from the United Network for Organ Sharing in January 2014.

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  • Cited by (0)

    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by the Research Enhancement Award Program, Office of Research and Development, Veterans Affairs, and supported in part by Health Resources and Services Administration contract 231-00-0115. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services.

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