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Morbidity and mortality after transjugular intrahepatic portosystemic shunt placement in patients with cirrhosis.
- Source :
-
European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2019 May; Vol. 31 (5), pp. 626-632. - Publication Year :
- 2019
-
Abstract
- Objectives: Transjugular intrahepatic portosystemic shunt (TIPS) is adopted to treat refractory complications of portal hypertension, such as variceal bleeding and ascites. This study aimed to assess predictors of hepatic encephalopathy (HE) development and cumulative transplant-free survival after TIPS placement in patients with cirrhosis complicated by refractory ascites and major gastroesophageal bleeding.<br />Materials and Methods: Sixty-three cirrhotic patients who underwent TIPS positioning as a secondary prophylaxis of major upper gastroesophageal bleeding (N=30) or to control refractory ascites (N=33) were enrolled.<br />Results: After a median follow-up of 26 months following TIPS insertion, only 1/30 (3.3%) patients developed reoccurrence of bleeding. Complete control of refractory ascites was recorded in 19/23 (82.6%) patients. Within the first month after TIPS placement, 34/63 (53.9%) patients developed clinically significant HE, which was associated with the baseline presence of type 2 hepatorenal syndrome (P=0.022). At the end of 90 months of follow-up, 35 (55.6%) patients were alive, 12 (19.0%) patients underwent liver transplantation, and 16 (25.4%) patients died. Independent predictors of transplant-free survival were a model for end-stage liver disease score up to 15 (P<0.001), the absence of a history of spontaneous bacterial peritonitis (P=0.010) pre-TIPS, and no HE within 1 month post-TIPS (P=0.040).<br />Conclusion: TIPS insertion can be considered a safe and effective treatment in patients with cirrhosis and severe complications of portal hypertension that are not manageable with standard treatments. Interestingly, if confirmed in future studies, the history of spontaneous bacterial peritonitis pre-TIPS could be added to the model for end-stage liver disease score as a strong baseline predictor of post-TIPS mortality.
- Subjects :
- Ascites etiology
Ascites mortality
Ascites physiopathology
Female
Gastrointestinal Hemorrhage etiology
Gastrointestinal Hemorrhage mortality
Gastrointestinal Hemorrhage physiopathology
Hepatic Encephalopathy etiology
Humans
Hypertension, Portal diagnosis
Hypertension, Portal etiology
Hypertension, Portal physiopathology
Liver Cirrhosis mortality
Liver Cirrhosis physiopathology
Male
Middle Aged
Portal Pressure
Portasystemic Shunt, Transjugular Intrahepatic mortality
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Ascites surgery
Gastrointestinal Hemorrhage prevention & control
Hypertension, Portal surgery
Liver Cirrhosis complications
Portasystemic Shunt, Transjugular Intrahepatic adverse effects
Secondary Prevention
Subjects
Details
- Language :
- English
- ISSN :
- 1473-5687
- Volume :
- 31
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- European journal of gastroenterology & hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 30550458
- Full Text :
- https://doi.org/10.1097/MEG.0000000000001342