Clin Mol Hepatol.
2014 Mar;20(1):18-27. 10.3350/cmh.2014.20.1.18.
Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data
- Affiliations
-
- 1Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea. liverkys@schmc.ac.kr
- 2Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
- 3Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea.
- 4Department of Internal Medicine, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea.
- 5Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
- 6Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea.
- 7Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 8Department of Internal Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea.
- 9Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
- 10Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.
- 11Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea.
- 12Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea.
- 13Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
- 14Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea.
- 15Department of Radiology, Soonchunhyang University College of Medicine, Bucheon, Korea.
- KMID: 1737595
- DOI: http://doi.org/10.3350/cmh.2014.20.1.18
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.
MeSH Terms
-
Adolescent
Adult
Aged
Aged, 80 and over
Asian Continental Ancestry Group
End Stage Liver Disease/pathology
Female
Follow-Up Studies
Hemorrhage/etiology
Hepatic Encephalopathy/etiology
Hospitals, University
Humans
Hypertension, Portal/*diagnosis/mortality/surgery
Kaplan-Meier Estimate
Male
Middle Aged
Odds Ratio
*Portasystemic Shunt, Transjugular Intrahepatic
Republic of Korea
Retrospective Studies
Risk Factors
Severity of Illness Index
Survival Rate
Treatment Outcome
Young Adult
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