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KMID : 1103920140200010018
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Korean Journal of Hepatology
2014 Volume.20 No. 1 p.18 ~ p.27
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Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data
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Kim Hyung-Ki
Kim Yoon-Jun
Chung Woo-Jin
Kim Soon-Sun
Shim Jae-Jun
Choi Moon-Seok
Kim Do-Young
Jun Dae-Won
Um Soon-Ho
Park Sung-Jae
Woo Hyun-Young
Jung Young-Kul
Baik Soon-Koo
Kim Moon-Young
Park Soo-Young
Lee Jae-Myeong
Kim Young-Seok
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Abstract
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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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KEYWORD
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Liver cirrhosis, Transjugular intrahepatic portosystemic shunt, Portal hypertension
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