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

Kim HK, Kim YJ, Chung WJ, Kim SS, Shim JJ, Choi MS, Kim do Y, Jun DW, Um SH, Park SJ, Woo HY, Jung YK, Baik SK, Kim MY, Park SY, Lee JM, Kim YS - Clin Mol Hepatol (2014)

Bottom Line: 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.Determining the appropriate indication is warranted to improve survival in these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.

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.

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Related in: MedlinePlus

Kaplan-Meier analysis of survival based on the serum creatinine level.
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Figure 3: Kaplan-Meier analysis of survival based on the serum creatinine level.

Mentions: There was a survival difference between patients with MELD scores higher or lower than 14 (P<0.001) (Fig. 1). Kaplan-Meier analysis also showed a significant survival difference between patients with CP class A vs. B (P=0.0018), class B vs. C (P<0.001), and class A vs. C (P<0.001) (Fig. 2) and a serum creatinine higher or lower than 1.0 mg/dL (P<0.001) (Fig. 3). But, response of ascites was not significant survival factor in patients with TIPS (P=0.28).


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

Kim HK, Kim YJ, Chung WJ, Kim SS, Shim JJ, Choi MS, Kim do Y, Jun DW, Um SH, Park SJ, Woo HY, Jung YK, Baik SK, Kim MY, Park SY, Lee JM, Kim YS - Clin Mol Hepatol (2014)

Kaplan-Meier analysis of survival based on the serum creatinine level.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3992326&req=5

Figure 3: Kaplan-Meier analysis of survival based on the serum creatinine level.
Mentions: There was a survival difference between patients with MELD scores higher or lower than 14 (P<0.001) (Fig. 1). Kaplan-Meier analysis also showed a significant survival difference between patients with CP class A vs. B (P=0.0018), class B vs. C (P<0.001), and class A vs. C (P<0.001) (Fig. 2) and a serum creatinine higher or lower than 1.0 mg/dL (P<0.001) (Fig. 3). But, response of ascites was not significant survival factor in patients with TIPS (P=0.28).

Bottom Line: 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.Determining the appropriate indication is warranted to improve survival in these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.

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.

Show MeSH
Related in: MedlinePlus