Original articlePancreas, biliary tract, and liverAssociation Between Transjugular Intrahepatic Portosystemic Shunt and Survival in Patients With Cirrhosis
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.
References (26)
- et al.
Effects of ascites resolution after successful TIPS on nutrition in cirrhotic patients with refractory ascites
Am J Gastroenterol
(2001) TIPS: 25 years later
J Hepatol
(2013)- et al.
Transjugular intrahepatic portosystemic stent-shunt for hepatorenal syndrome
Lancet
(1997) - et al.
Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis
Gastroenterology
(2002) - et al.
The North American study for the treatment of refractory ascites
Gastroenterology
(2003) - et al.
Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. French Group of Clinicians and a Group of Biologists
J Hepatol
(1996) - et al.
Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data
Gastroenterology
(2007) - et al.
Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: a meta-analysis
Hepatology
(1999) - et al.
Transjugular intrahepatic portosystemic shunts: adjunctive embolotherapy of gastroesophageal collateral vessels in the prevention of variceal rebleeding
Radiology
(2005) - et al.
A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding
Endoscopy
(2007)
TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update
Gut
Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients
Eur J Gastroenterol Hepatol
Review article: pathogenesis and pathophysiology of hepatorenal syndrome–is there scope for prevention?
Aliment Pharmacol Ther
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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.