Association Between Transjugular Intrahepatic Portosystemic Shunt and Survival in Patients With Cirrhosis

作者：Berry Kristin; Lerrigo Robert; Liou Iris W; Ioannou George N^*

来源：Clinical Gastroenterology and Hepatology, 2016, 14(1): 118-123.

DOI：10.1016/j.cgh.2015.06.042

• MELD Score
• Hepatorenal Syndrome
• Hepatic Hydrothorax
• Hepatocellular Carcinoma
• Transjugular Intrahepatic Portosystemic Shunt
• TIPS
• Cirrhosis
• Mortality
• Liver Transplantation

BACKGROUND & AIMS: A transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of refractory ascites and variceal bleeding. However, it is unclear whether a TIPS affects long-term survival. We investigated whether a TIPS is associated with survival in patients with cirrhosis awaiting liver transplantation.
METHODS: By using the United Network for Organ Sharing registries from 2002 to 2013, we followed up a cohort of transplant-naive adults with cirrhosis (N = 97,063) from the time of transplant listing until the time of death or transplantation. We used Cox proportional hazards and competing-risks analyses to compare these primary outcomes between patients with a TIPS (n = 7475; 7.7%) and without a TIPS (n = 89,588; 92.3%) at the time of listing, adjusting for baseline characteristics.
RESULTS: During an average follow-up period of 1.61 years, 23,305 (24%) patients died before undergoing transplantation, 47,563 (49%) underwent transplantation, and the remaining 26,195 (27%) still were alive without having received a liver transplant. Compared with patients without a TIPS, patients with a TIPS had a lower risk of death (adjusted subhazard ratio, 0.95; 95% confidence interval, 0.9-0.99), transplantation (adjusted subhazard ratio, 0.92, 95% confidence interval, 0.88-0.95), or the combined outcome of death or transplantation (adjusted hazard ratio, 0.85; 95% confidence interval, 0.83-0.88).
CONCLUSIONS: Among patients with cirrhosis awaiting liver transplantation, patients with a TIPS had a lower mortality rate than patients without a TIPS.

• 出版日期2016-1