Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension

Korean multicenter real-practice data

Hyung K.i. Kim, Yoon J.un Kim, Woo J.in Chung, Soon S.un Kim, Jae J.un Shim, Moon S.eok Choi, Do Y.oung Kim, Dae W.on Jun, Soon-Ho Um, Sung J.ae Park, Hyun Y.oung Woo, Young Kul Jung, Soon K.oo Baik, Moon Y.oung Kim, Soo Y.oung Park, Jae M.yeong Lee, Young S.eok Kim

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)18-27
Number of pages10
JournalClinical and molecular hepatology
Volume20
Issue number1
DOIs
Publication statusPublished - 2014 Mar 1
Externally publishedYes

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Transjugular Intrahepatic Portasystemic Shunt
Portal Hypertension
End Stage Liver Disease
Hemorrhage
Ascites
Stents
Hepatic Encephalopathy
Mortality
Serum Albumin
Liver Cirrhosis
Survival Rate
Retrospective Studies
Survival

Keywords

  • Liver cirrhosis
  • Portal hypertension
  • Transjugular intrahepatic portosystemic shunt

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kim, H. K. I., Kim, Y. J. U., Chung, W. J. I., Kim, S. S. U., Shim, J. J. U., Choi, M. S. E., ... Kim, Y. S. E. (2014). Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data. Clinical and molecular hepatology, 20(1), 18-27. https://doi.org/10.3350/cmh.2014.20.1.18

Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension : Korean multicenter real-practice data. / Kim, Hyung K.i.; Kim, Yoon J.un; Chung, Woo J.in; Kim, Soon S.un; Shim, Jae J.un; Choi, Moon S.eok; Kim, Do Y.oung; Jun, Dae W.on; Um, Soon-Ho; Park, Sung J.ae; Woo, Hyun Y.oung; Jung, Young Kul; Baik, Soon K.oo; Kim, Moon Y.oung; Park, Soo Y.oung; Lee, Jae M.yeong; Kim, Young S.eok.

In: Clinical and molecular hepatology, Vol. 20, No. 1, 01.03.2014, p. 18-27.

Research output: Contribution to journalArticle

Kim, HKI, Kim, YJU, Chung, WJI, Kim, SSU, Shim, JJU, Choi, MSE, Kim, DYO, Jun, DWO, Um, S-H, Park, SJA, Woo, HYO, Jung, YK, Baik, SKO, Kim, MYO, Park, SYO, Lee, JMY & Kim, YSE 2014, 'Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data', Clinical and molecular hepatology, vol. 20, no. 1, pp. 18-27. https://doi.org/10.3350/cmh.2014.20.1.18
Kim, Hyung K.i. ; Kim, Yoon J.un ; Chung, Woo J.in ; Kim, Soon S.un ; Shim, Jae J.un ; Choi, Moon S.eok ; Kim, Do Y.oung ; Jun, Dae W.on ; Um, Soon-Ho ; Park, Sung J.ae ; Woo, Hyun Y.oung ; Jung, Young Kul ; Baik, Soon K.oo ; Kim, Moon Y.oung ; Park, Soo Y.oung ; Lee, Jae M.yeong ; Kim, Young S.eok. / Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension : Korean multicenter real-practice data. In: Clinical and molecular hepatology. 2014 ; Vol. 20, No. 1. pp. 18-27.
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AU - Kim, Hyung K.i.

AU - Kim, Yoon J.un

AU - Chung, Woo J.in

AU - Kim, Soon S.un

AU - Shim, Jae J.un

AU - Choi, Moon S.eok

AU - Kim, Do Y.oung

AU - Jun, Dae W.on

AU - Um, Soon-Ho

AU - Park, Sung J.ae

AU - Woo, Hyun Y.oung

AU - Jung, Young Kul

AU - Baik, Soon K.oo

AU - Kim, Moon Y.oung

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N2 - 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.

AB - 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.

KW - Liver cirrhosis

KW - Portal hypertension

KW - Transjugular intrahepatic portosystemic shunt

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