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Prosthetic H-graft portacaval shunts vs transjugular intrahepatic portasystemic stent shunts: 18-year follow-up of a randomized trial.
J Am Coll Surg. 2012 Apr; 214(4):445-53; discussion 453-5.JA

Abstract

BACKGROUND

Widespread application of transjugular intrahepatic portasystemic shunt (TIPS) continues despite the lack of trials documenting efficacy superior to surgical shunting. Here we present an 18-year follow-up of a prospective randomized trial comparing TIPS with small-diameter prosthetic H-graft portacaval shunt (HGPCS) for portal decompression.

STUDY DESIGN

Beginning in 1993, patients were prospectively randomized to undergo either TIPS or HGPCS as definitive therapy for portal hypertension due to cirrhosis. Complications of shunting and long-term outcomes were noted. Failure of shunting was prospectively defined as the inability to place shunt, irreversible shunt occlusion, major variceal rehemorrhage, unanticipated liver transplantation, or death. Survival and shunt failure were compared using Kaplan-Meier curve analysis. Median data are reported.

RESULTS

Patient presentation, circumstances of shunting, causes of cirrhosis, severity of hepatic dysfunction (eg, Child's class, Model for End-Stage Liver Disease score), and predicted survival after shunting did not differ between patients undergoing TIPS (n = 66) or HGPCS (n = 66). Survival was significantly longer after HGPCS for patients of Child's class A (91 vs 19 months; p = 0.009) or class B (63 vs 21 months; p = 0.02). Shunt failure occurred later after HGPCS than TIPS (45 vs 22 months; p = 0.04).

CONCLUSIONS

Compared with TIPS, survival after HGPCS was superior for patients with better liver function (eg, Child's class A or B). Shunt failure after HGPCS occurred later than after TIPS. Rather than TIPS, application of HGPCS is preferred for patients with complicated cirrhosis and better hepatic function.

Authors+Show Affiliations

Tampa General Medical Group, Tampa General Hospital, Tampa, FL 33606, USA. arosemurgy@tgh.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

22463885

Citation

Rosemurgy, Alexander S., et al. "Prosthetic H-graft Portacaval Shunts Vs Transjugular Intrahepatic Portasystemic Stent Shunts: 18-year Follow-up of a Randomized Trial." Journal of the American College of Surgeons, vol. 214, no. 4, 2012, pp. 445-53; discussion 453-5.
Rosemurgy AS, Frohman HA, Teta AF, et al. Prosthetic H-graft portacaval shunts vs transjugular intrahepatic portasystemic stent shunts: 18-year follow-up of a randomized trial. J Am Coll Surg. 2012;214(4):445-53; discussion 453-5.
Rosemurgy, A. S., Frohman, H. A., Teta, A. F., Luberice, K., & Ross, S. B. (2012). Prosthetic H-graft portacaval shunts vs transjugular intrahepatic portasystemic stent shunts: 18-year follow-up of a randomized trial. Journal of the American College of Surgeons, 214(4), 445-53; discussion 453-5. https://doi.org/10.1016/j.jamcollsurg.2011.12.042
Rosemurgy AS, et al. Prosthetic H-graft Portacaval Shunts Vs Transjugular Intrahepatic Portasystemic Stent Shunts: 18-year Follow-up of a Randomized Trial. J Am Coll Surg. 2012;214(4):445-53; discussion 453-5. PubMed PMID: 22463885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prosthetic H-graft portacaval shunts vs transjugular intrahepatic portasystemic stent shunts: 18-year follow-up of a randomized trial. AU - Rosemurgy,Alexander S, AU - Frohman,Heather A, AU - Teta,Anthony F, AU - Luberice,Kenneth, AU - Ross,Sharona B, PY - 2011/12/13/received PY - 2011/12/15/accepted PY - 2012/4/3/entrez PY - 2012/4/3/pubmed PY - 2012/7/28/medline SP - 445-53; discussion 453-5 JF - Journal of the American College of Surgeons JO - J Am Coll Surg VL - 214 IS - 4 N2 - BACKGROUND: Widespread application of transjugular intrahepatic portasystemic shunt (TIPS) continues despite the lack of trials documenting efficacy superior to surgical shunting. Here we present an 18-year follow-up of a prospective randomized trial comparing TIPS with small-diameter prosthetic H-graft portacaval shunt (HGPCS) for portal decompression. STUDY DESIGN: Beginning in 1993, patients were prospectively randomized to undergo either TIPS or HGPCS as definitive therapy for portal hypertension due to cirrhosis. Complications of shunting and long-term outcomes were noted. Failure of shunting was prospectively defined as the inability to place shunt, irreversible shunt occlusion, major variceal rehemorrhage, unanticipated liver transplantation, or death. Survival and shunt failure were compared using Kaplan-Meier curve analysis. Median data are reported. RESULTS: Patient presentation, circumstances of shunting, causes of cirrhosis, severity of hepatic dysfunction (eg, Child's class, Model for End-Stage Liver Disease score), and predicted survival after shunting did not differ between patients undergoing TIPS (n = 66) or HGPCS (n = 66). Survival was significantly longer after HGPCS for patients of Child's class A (91 vs 19 months; p = 0.009) or class B (63 vs 21 months; p = 0.02). Shunt failure occurred later after HGPCS than TIPS (45 vs 22 months; p = 0.04). CONCLUSIONS: Compared with TIPS, survival after HGPCS was superior for patients with better liver function (eg, Child's class A or B). Shunt failure after HGPCS occurred later than after TIPS. Rather than TIPS, application of HGPCS is preferred for patients with complicated cirrhosis and better hepatic function. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/22463885/Prosthetic_H_graft_portacaval_shunts_vs_transjugular_intrahepatic_portasystemic_stent_shunts:_18_year_follow_up_of_a_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(12)00038-5 DB - PRIME DP - Unbound Medicine ER -