Differences in long-term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed

Fernando Membreno, Arturo L. Baez, Reka Pandula, Eric Walser, Daryl T.Y. Lau

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Objective: To compare the survival after transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites and variceal bleed, and to identify the factors predictive of survival. Methods: Single tertiary center, retrospective-prospective study. Chart review was performed on all patients who underwent TIPS between 1993 and 2000 and prospective follow-up to determine survival. Pre- and post-TIPS clinical parameters were compared and Kaplan-Meier analysis was applied to compare the survival of both groups. Cox regression was used to identify predictors of survival after TIPS. Results: A total of 163 patients were included, 62 with refractory ascites and 101 with variceal bleed. Both groups had similar age (48.2 vs 48.9 year; P = 0.65) and consisted of predominantly Caucasians (51%) and Mexican-Americans (39%). More than 75% had chronic hepatitis C, alcoholic liver disease or both. Overall, the median survival was significantly better for variceal bleed (2 years) compared with refractory ascites (6 months) (P < 0.001). This survival advantage persisted in patients with Mayo risk score greater than 1.17. Transjugular intrahepatic portosystemic shunt improved severe ascites in 45% of patients (P = 0.03). Mayo risk score was highly predictive of survival afterTIPS with a hazard ratio of 2.3, followed by Child-Pugh score, creatinine, albumin and ethnicity, with better survival among Mexican-Americans. Shunt dysfunction (31%) and hepatic encephalopathy (27%) were the most common complications of TIPS. Conclusions: Patients who received TIPS for variceal bleed had significantly longer survival compared with those for refractory ascites. Mexican-Americans had an improved long-term survival compared with Caucasians. The reason for this ethnic difference in survival is unclear and warrants further prospective evaluation.

Original languageEnglish (US)
Pages (from-to)474-481
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume20
Issue number3
DOIs
StatePublished - Mar 2005

Keywords

  • Ascites
  • Portal hypertension
  • Transjugular intrahepatic portosystemic shunt
  • Variceal bleed

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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