Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data.
- Author:
Hyung Ki KIM
1
;
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
Author Information
- Publication Type:Original Article ; Multicenter Study
- Keywords: Liver cirrhosis; Transjugular intrahepatic portosystemic shunt; Portal hypertension
- MeSH: Adolescent; Adult; Aged; Aged, 80 and over; Asian Continental Ancestry Group; End Stage Liver Disease/pathology; Female; Follow-Up Studies; Hemorrhage/etiology; Hepatic Encephalopathy/etiology; Hospitals, University; Humans; Hypertension, Portal/*diagnosis/mortality/surgery; Kaplan-Meier Estimate; Male; Middle Aged; Odds Ratio; *Portasystemic Shunt, Transjugular Intrahepatic; Republic of Korea; Retrospective Studies; Risk Factors; Severity of Illness Index; Survival Rate; Treatment Outcome; Young Adult
- From:Clinical and Molecular Hepatology 2014;20(1):18-27
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: This retrospective study assessed the clinical outcome of a transjugular intrahepatic portosystemic shunt (TIPS) procedure for managing portal hypertension in Koreans with liver cirrhosis. METHODS: Between January 2003 and July 2013, 230 patients received a TIPS in 13 university-based hospitals. RESULTS: Of 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. CONCLUSIONS: A 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.
