1. Long-term clinical outcome and survival predictors in patients with cirrhosis after 10-mm-covered transjugular intrahepatic portosystemic shunt.
- Author
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Tejedor-Tejada J, Fuentes-Valenzuela E, García-Pajares F, Nájera-Muñoz R, Almohalla-Álvarez C, Sánchez-Martín F, Calero-Aguilar H, Villacastín-Ruiz E, Pintado-Garrido R, and Sánchez-Antolín G
- Subjects
- Adult, Aged, Aged, 80 and over, Ascites mortality, Ascites surgery, Esophageal and Gastric Varices complications, Esophageal and Gastric Varices mortality, Esophageal and Gastric Varices surgery, Female, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage mortality, Gastrointestinal Hemorrhage surgery, Hepatic Encephalopathy epidemiology, Hepatic Encephalopathy mortality, Hepatic Encephalopathy prevention & control, Hepatic Veins diagnostic imaging, Hepatic Veins surgery, Humans, Hydrothorax mortality, Hydrothorax surgery, Hypertension, Portal mortality, Kaplan-Meier Estimate, Liver Cirrhosis mortality, Male, Middle Aged, Polytetrafluoroethylene, Portasystemic Shunt, Transjugular Intrahepatic adverse effects, Portasystemic Shunt, Transjugular Intrahepatic mortality, Postoperative Complications epidemiology, Postoperative Complications mortality, Proportional Hazards Models, Prosthesis Design, Renal Insufficiency mortality, Retrospective Studies, Serum Albumin, Sodium blood, Treatment Outcome, Hypertension, Portal complications, Liver Cirrhosis complications, Portasystemic Shunt, Transjugular Intrahepatic methods, Stents
- Abstract
Background and Aims: Transjugular intrahepatic portosystemic shunts (TIPS) are successfully used in the management of portal hypertension (PH)-related complications. Debate surrounds the diameter of the dilation. The aim was to analyse the outcomes of and complications deriving from TIPS in patients with cirrhosis and identify predictors of survival., Methods: This was a retrospective single-centre study, which included patients with cirrhosis who had a TIPS procedure for PH from 2009 to October 2018. Demographic, clinical and radiological data were collected. The Kaplan-Meier method was used to measure survival and predictors of survival were identified with the Cox regression model., Results: A total of 98 patients were included (78.6% male), mean age was 58.5 (SD±/-9.9) and the median MELD was 13.3 (IQR 9.5-16). The indications were refractory ascites (RA), variceal bleeding (VB) and hepatic hydrothorax (HH). Median survival was 72 months (RA 46.4, VB 68.5 and HH 64.7) and transplant-free survival was 26 months. Clinical and technical success rates were 70.5% and 92.9% respectively. Age (HR 1.05), clinical success (HR 0.33), sodium (HR 0.92), renal failure (HR 2.46) and albumin (HR 0.35) were predictors of survival. Hepatic encephalopathy occurred in 28.6% of patients and TIPS dysfunction occurred in 16.3%., Conclusions: TIPS with 10-mm PTFE-covered stent is an effective and safe treatment for PH-related complications in patients with cirrhosis. Age, renal failure, sodium, albumin and clinical success are independent predictors of long-term survival., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.) more...
- Published
- 2021
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