Influence of transjugular intrahepatic portosystemic shunt in patients awaiting orthotopic liver transplant on post-transplant outcome

Abstract

BackgroundThis study was conducted to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunts (TIPS) in patients awaiting orthotopic liver transplantation (OLT) and to identify factors affecting post-transplant survival. MethodsConsecutive patients who underwent TIPS followed by OLT between January 1991 and December 2008 were included in the study. The Kaplan–Meier method was used for survival analysis. Survival curves were compared using the log rank test. ResultsA total of 129 patients underwent TIPS followed by OLT and were included in our study. The mean age of the group was 54.67 years (SD, 11.45; range, 16–74 years). The mean duration of follow-up was 2.3 years (range, 1 day–15 years). The mean duration between first TIPS placement and OLT was 1.5 years (range, 0.1–13.4 years). The post-transplant survival rates at 1 month, 1 year, 3 years, 5 years, and 10 years were 98%, 82%, 75%, 69%, and 43%, respectively. The technical success rate of the OLT was 100% in patients who had undergone pre-transplant TIPS. The post-transplant survival was not influenced by pre-TIPS portosystemic gradient (P = 0.295) or the drop in pressure after TIPS (P = 0.423). On multivariate analysis, hepatitis C virus positivity [P = 0.001; hazard ratio = 2.50 (1.47–4.25)] and Model for End-stage Liver Disease score [P = 0.015; hazard ratio = 2.45 (1.19–5.02)] were found to be significant predictors of post-transplant long-term survival. The incidence of post-TIPS complications was 32.6% (42/129). The most common complication was procedure-related bleeding (8.5%) followed by hepatic encephalopathy (7.0%). ConclusionPost-transplant survival in patients who undergo TIPS before OLT is excellent. Higher Model for End-stage Liver Disease scores and hepatitis C positivity result in worse post-transplant survival.