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Differences in long-term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed.
J Gastroenterol Hepatol. 2005 Mar; 20(3):474-81.JG

Abstract

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.

Authors+Show Affiliations

Department of Internal Medicine, The University of Texas Medical Branch of Galveston, Texas, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15740494

Citation

Membreno, Fernando, et al. "Differences in Long-term Survival After Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites and Variceal Bleed." Journal of Gastroenterology and Hepatology, vol. 20, no. 3, 2005, pp. 474-81.
Membreno F, Baez AL, Pandula R, et al. Differences in long-term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed. J Gastroenterol Hepatol. 2005;20(3):474-81.
Membreno, F., Baez, A. L., Pandula, R., Walser, E., & Lau, D. T. (2005). Differences in long-term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed. Journal of Gastroenterology and Hepatology, 20(3), 474-81.
Membreno F, et al. Differences in Long-term Survival After Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites and Variceal Bleed. J Gastroenterol Hepatol. 2005;20(3):474-81. PubMed PMID: 15740494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differences in long-term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed. AU - Membreno,Fernando, AU - Baez,Arturo L, AU - Pandula,Reka, AU - Walser,Eric, AU - Lau,Daryl T-Y, PY - 2005/3/3/pubmed PY - 2005/7/1/medline PY - 2005/3/3/entrez SP - 474 EP - 81 JF - Journal of gastroenterology and hepatology JO - J Gastroenterol Hepatol VL - 20 IS - 3 N2 - 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. SN - 0815-9319 UR - https://www.unboundmedicine.com/medline/citation/15740494/Differences_in_long_term_survival_after_transjugular_intrahepatic_portosystemic_shunt_for_refractory_ascites_and_variceal_bleed_ L2 - https://doi.org/10.1111/j.1440-1746.2005.03601.x DB - PRIME DP - Unbound Medicine ER -