Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data

• Main Authors: Hyung Ki Kim, Yoon Jun Kim, Woo Jin Chung, Soon Sun Kim, Jae Jun Shim, Moon Seok Choi, Do Young Kim, Dae Won Jun, Soon Ho Um, Sung Jae Park, Hyun Young Woo, Young Kul Jung, Soon Koo Baik, Moon Young Kim, Soo Young Park, Jae Myeong Lee, Young Seok Kim
• Format: Article
• Language: English
• Published: Korean Association for the Study of the Liver 2014-03-01
• Series: Clinical and Molecular Hepatology
• Subjects: Liver cirrhosis; Transjugular intrahepatic portosystemic shunt; Portal hypertension
• Online Access: http://e-cmh.org/upload/pdf/cmh-20-18.pdf

Background/AimsThis retrospective study assessed the clinical outcome of a transjugular intrahepatic portosystemic shunt (TIPS) procedure for managing portal hypertension in Koreans with liver cirrhosis.MethodsBetween January 2003 and July 2013, 230 patients received a TIPS in 13 university-based hospitals.ResultsOf the 229 (99.6%) patients who successfully underwent TIPS placement, 142 received a TIPS for variceal bleeding, 84 for refractory ascites, and 3 for other indications. The follow-up period was 24.9±30.2 months (mean±SD), 74.7% of the stents were covered, and the primary patency rate at the 1-year follow-up was 78.7%. Hemorrhage occurred in 30 (21.1%) patients during follow-up; of these, 28 (93.3%) cases of rebleeding were associated with stent dysfunction. Fifty-four (23.6%) patients developed new hepatic encephalopathy, and most of these patients were successfully managed conservatively. The cumulative survival rates at 1, 6, 12, and 24 months were 87.5%, 75.0%, 66.8%, and 57.5%, respectively. A high Model for End-Stage Liver Disease (MELD) score was significantly associated with the risk of death within the first month after receiving a TIPS (P=0.018). Old age (P<0.001), indication for a TIPS (ascites vs. bleeding, P=0.005), low serum albumin (P<0.001), and high MELD score (P=0.006) were associated with overall mortality.ConclusionsA high MELD score was found to be significantly associated with early and overall mortality rate in TIPS patients. Determining the appropriate indication is warranted to improve survival in these patients.