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Transjugular Intrahepatic Porto-Systemic Shunt in Patients with Liver Cirrhosis and Model for End-Stage Liver Disease ≥15

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Abstract

Background

It is not known whether transjugular intrahepatic porto-systemic shunt (TIPS) is safe in patients with advanced liver cirrhosis. The aim of our study was to evaluate the impact of TIPS on transplant-free survival in patients with liver cirrhosis and MELD score ≥15.

Methods

All adult patients who underwent TIPS at our institution between 2004 and 2011 were identified (N = 470). A total of 144 patients had MELD ≥15 at the time of TIPS. These patients were matched 1:1 to patients with liver cirrhosis who did not undergo TIPS based on age and MELD score using the greedy algorithm. Patients were followed up until time of death or liver transplantation. Kaplan–Meier curves and log-rank tests were used to test for differences in survival outcome between the two groups.

Results

A total of 288 patients with liver cirrhosis were included, of whom 144 underwent TIPS and 144 did not. The two groups were matched based on age and MELD score and were comparable with regard to gender and ethnicity. Mean MELD and Child–Pugh scores in the study population were 20.9 ± 6.5 and 10.5 ± 1.8, respectively. The most common indication for TIPS was varices (49 %), followed by refractory ascites (42 %). In the first 2 months post-TIPS, there was increased mortality or liver transplantation in patients who had TIPS compared to those who did not, but this did not reach statistical significance (p = 0.07). However, after 2 months, TIPS is associated with 56 % lower risk of dying or needing liver transplantation (p < 0.01) than cirrhotic patients who did not undergo TIPS.

Conclusion

In patients with liver cirrhosis and MELD ≥15, TIPS might improve transplant-free survival for patients who live for at least 2 months after the procedure.

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References

  1. García-pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362:2370–2379.

    Article  PubMed  Google Scholar 

  2. Bhogal HK, Sanyal AJ. Using transjugular intrahepatic portosystemic shunts for complications of cirrhosis. Clin Gastroenterol Hepatol. 2011;9:936–946.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bai M, Qi XS, Yang ZP, Yang M, Fan DM, Han GH. TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: an updated meta-analysis. World J Gastroenterol. 2014;20:2704–2714.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chen H, Bai M, Qi X, et al. Child-Na score: a predictive model for survival in cirrhotic patients with symptomatic portal hypertension treated with TIPS. PLoS ONE. 2013;8:e79637.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Boyer TD, Haskal ZJ. AASLD practice guideline update. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology. 2010;57:1–16.

    Google Scholar 

  6. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, Terborg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864–871.

    Article  CAS  PubMed  Google Scholar 

  7. Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60:715–735.

    Article  PubMed  Google Scholar 

  8. Moore KP, Wong F, Gines P, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003;2003:258–266.

    Article  Google Scholar 

  9. Garcia-tsao G. Transjugular intrahepatic portosystemic shunt in the management of refractory ascites. Semin Intervent Radiol. 2005;22:278–286.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Casadaban LC, Parvinian A, Zivin SP, et al. MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort. Ann Hepatol. 2015;14:380–388.

    PubMed  Google Scholar 

  11. Garcia-pagán JC, Di pascoli M, Caca K, et al. Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study. J Hepatol. 2013;58:45–50.

    Article  PubMed  Google Scholar 

  12. Gaba RC, Couture PM, Bui JT, et al. Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation. J Vasc Interv Radiol. 2013;24:411–420. (420.e1–4).

    Article  PubMed  Google Scholar 

  13. Thuluvath PJ, Bal JS, Mitchell S, Lund G, Venbrux A. TIPS for management of refractory ascites: response and survival are both unpredictable. Dig Dis Sci. 2003;48:542–550.

    Article  PubMed  Google Scholar 

  14. Salerno F, Cammà C, Enea M, Rössle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology. 2007;133:825-34.b.

    Article  Google Scholar 

  15. Albillos A, Bañares R, González M, Catalina MV, Molinero LM. A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites. J Hepatol. 2005;43:990–996.

    Article  PubMed  Google Scholar 

  16. Dhanasekaran R, Gonzales P, West J, Subramanian R, Parekh S, Spivey JR, Reshamwala P, Martin LG, Kim HS. Predictors of early mortality post transjugular intrahepatic portosystemic shunts and the role of hepatic venous pressure gradient, Gastrointest. Interv. 2012;1:63–68. ISSN:2213-1795, doi:10.1016/j.gii.2012.08.008.

  17. Monescillo A, Martínez-Lagares F, Ruiz-Del-Arbol L, et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology. 2004;40:793–801. doi:10.1002/hep.1840400408.

    Article  PubMed  Google Scholar 

  18. http://www.uptodate.com/contents/model-for-end-stage-liver-disease-meld. Accessed 29 June 2015.

  19. Ferral H, Gamboa P, Postoak DW, et al. Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for end-stage liver disease score. Radiology. 2004;231:231–236.

    Article  PubMed  Google Scholar 

  20. Kim HK, Kim YJ, Chung WJ, et al. Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data. Clin Mol Hepatol. 2014;20:18–27.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Choe WH. Do cirrhotic patients with a high MELD score benefit from TIPS? Clin Mol Hepatol. 2014;20:15–17.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chen RP, Zhu ge XJ, Huang ZM, et al. Prophylactic use of transjugular intrahepatic portosystemic shunt aids in the treatment of refractory ascites: metaregression and trial sequential meta-analysis. J Clin Gastroenterol. 2014;48:290–299.

    Article  PubMed  Google Scholar 

  23. Deltenre P, Mathurin P, Dharancy S, et al. Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta-analysis. Liver Int. 2005;25:349–356.

    Article  CAS  PubMed  Google Scholar 

  24. Somberg KA, Riegler JL, Laberge JM, et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunts: incidence and risk factors. Am J Gastroenterol. 1995;90:549–555.

    CAS  PubMed  Google Scholar 

  25. Riggio O, Masini A, Efrati C, et al. Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: a randomized controlled study. J Hepatol. 2005;42:674–679.

    Article  CAS  PubMed  Google Scholar 

  26. Angermayr B, Cejna M, Karnel F, et al. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut. 2003;52:879–885.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Salerno F, Merli M, Cazzaniga M, et al. MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol. 2002;36:494–500.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA

    Mona Ascha, Mustafa S. Ascha & Nizar N. Zein

  2. Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA

    Mohamad Hanouneh

  3. Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA

    Mark Sands

  4. Department of Quantitative Health Science, Cleveland Clinic, Cleveland, OH, USA

    Rocio Lopez

  5. Minnesota Gastroenterology, P.A., P.O. Box 14909, Minneapolis, MN, 55414, USA

    Ibrahim A. Hanouneh

Authors
  1. Mona Ascha
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  2. Mohamad Hanouneh
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  3. Mustafa S. Ascha
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  4. Nizar N. Zein
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Correspondence to Ibrahim A. Hanouneh.

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Supplemental Fig. 1

30-Day OLT-free survival (DOCX 82 kb)

Supplemental Fig. 2

90-Day OLT-free survival (DOCX 108 kb)

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Ascha, M., Hanouneh, M., S. Ascha, M. et al. Transjugular Intrahepatic Porto-Systemic Shunt in Patients with Liver Cirrhosis and Model for End-Stage Liver Disease ≥15. Dig Dis Sci 62, 534–542 (2017). https://doi.org/10.1007/s10620-016-4185-3

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  • DOI: https://doi.org/10.1007/s10620-016-4185-3

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