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Differences in long‐term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed
Author(s) -
MEMBRENO FERNANDO,
BAEZ ARTURO L,
PANDULA REKA,
WALSER ERIC,
LAU DARYL TY
Publication year - 2005
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2005.03601.x
Subject(s) - medicine , transjugular intrahepatic portosystemic shunt , ascites , gastroenterology , hepatic encephalopathy , hazard ratio , proportional hazards model , surgery , portal hypertension , portosystemic shunt , prospective cohort study , liver disease , survival analysis , cirrhosis , retrospective cohort study , confidence interval
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 after TIPS 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.