Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 7, 2012; 18(37): 5211-5218
Published online Oct 7, 2012. doi: 10.3748/wjg.v18.i37.5211
Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis
Hauke S Heinzow, Philipp Lenz, Michael Köhler, Frank Reinecke, Hansjörg Ullerich, Wolfram Domschke, Dirk Domagk, Tobias Meister
Hauke S Heinzow, Philipp Lenz, Frank Reinecke, Hansjörg Ullerich, Wolfram Domschke, Dirk Domagk, Tobias Meister, Department of Medicine B, University of Muenster, D-48149 Muenster, Germany
Michael Köhler, Institute of Radiology, University of Muenster, D-48149 Muenster, Germany
Tobias Meister, Department of Medicine II, Helios Albert-Schweitzer-Hospital, D-37154 Northeim, Germany
Author contributions: Heinzow HS and Lenz P contributed equally to this work, they designed the study, analysed and interpreted the data, and helped with drafting of the manuscript; Lenz P helped with technical and material support; Reinecke F collected the data; Köhler M, Ullerich H, Domagk D showed the transjugular intrahepatic portosystemic stent shunt interventions, and performed critical revision of the manuscript for important intellectual content; Domagk D revised the manuscript for study concept, analysis and interpretation of data; Domschke W revised the manuscript for important intellectual content; Meister T studied the concept, designed, analysed and interpreted data, and helped with drafting of the manuscript, statistical analysis, study supervision and final approval of the version to be published.
Supported by A research fellowship from the Faculty of Medicine, Westfälische Wilhelms-Universität Münster
Correspondence to: Tobias Meister, MD, Department of Medicine II, Helios Albert-Schweitzer-Klinik, Sturmbäume 8-10, D-37154 Northeim, Germany. tobiasmeister@gmx.de
Telephone: +49-5551-971244 Fax: +49-5551-971420
Received: January 31, 2012
Revised: March 20, 2012
Accepted: April 9, 2012
Published online: October 7, 2012
Abstract

AIM: To determine the clinical outcome and predictors of survival after transjugular intrahepatic portosystemic stent shunt (TIPS) implantation in cirrhotic patients.

METHODS: Eighty-one patients with liver cirrhosis and consequential portal hypertension had TIPS implantation (bare metal) for either refractory ascites (RA) (n = 27) or variceal bleeding (VB) (n = 54). Endpoints for the study were: technical success, stent occlusion and stent stenosis, rebleeding, RA and mortality. Clinical records of patients were collected and analysed. Baseline characteristics [e.g., age, sex, CHILD score and the model for end-stage liver disease score (MELD score), underlying disease] were retrieved. The Kaplan-Meier method was employed to calculate survival from the time of TIPS implantation and comparisons were made by log rank test. A multivariate analysis of factors influencing survival was carried out using the Cox proportional hazards regression model. Results were expressed as medians and ranges. Comparisons between groups were performed by using the Mann-Whitney U-test and the χ2 test as appropriate.

RESULTS: No difference could be seen in terms of age, sex, underlying disease or degree of portal pressure gradient (PPG) reduction between the ascites and the bleeding group. The PPG significantly decreased from 23.4 ± 5.3 mmHg (VB) vs 22.1 ± 5.5 mmHg (RA) before TIPS to 11.8 ± 4.0 vs 11.7 ± 4.2 after TIPS implantation (P = 0.001 within each group). There was a tendency towards more patients with stage CHILD A in the bleeding group compared to the ascites group (24 vs 6, P = 0.052). The median survival for the ascites group was 29 mo compared to > 60 mo for the bleeding group (P = 0.009). The number of radiological controls for stent patency was 6.3 for bleeders and 3.8 for ascites patients (P = 0.029). Kaplan-Meier calculation indicated that stent occlusion at first control (P = 0.027), ascites prior to TIPS implantation (P = 0.009), CHILD stage (P = 0.013), MELD score (P = 0.001) and those patients not having undergone liver transplantation (P = 0.024) were significant predictors of survival. In the Cox regression model, stent occlusion (P = 0.022), RA (P = 0.043), CHILD stage (P = 0.015) and MELD score (P = 0.004) turned out to be independent prognostic factors of survival. The anticoagulation management (P = 0.097), the porto-systemic pressure gradient (P = 0.460) and rebleeding episodes (P = 0.765) had no significant effect on the overall survival.

CONCLUSION: RA, stent occlusion, initial CHILD stage and MELD score are independent predictors of survival in patients with TIPS, speaking for a close follow-up in these circumstances.

Keywords: Transjugular intrahepatic portosystemic stent shunt; Liver cirrhosis; Ascites; Gastrointestinal hemorrhage; Treatment outcome