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Transjugular intrahepatic portosystemic shunt in nonliver transplant candidates: is it indicated?
Am J Gastroenterol. 1995 Aug; 90(8):1238-43.AJ

Abstract

BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of severe portal hypertension complications. Liver transplantation (LT) candidacy has not been a prerequisite to TIPS placement in some medical centers.

OBJECTIVES

To investigate the outcome and survival of non-LT candidates after TIPS.

METHODS

From November 1991 to February 1994, all patients referred for TIPS placement were evaluated for LT candidacy. Exclusions for LT included: age (> 70 yr), other significant medical conditions, or noncompliance. Indications for TIPS included refractory variceal bleeding during an acute bleed, recurrent bleeding after more than or equal to four sessions of sclerotherapy, or refractory ascites.

RESULTS

Sixty patients received TIPS. Nineteen were considered non-LT candidates. Over a 2-yr follow-up, 14 of these non-LT candidates did not survive. Their median age was 63.5 compared with 56.5 yr for LT candidate nonsurvivors (p < 0.05). Among the 14 non-LT candidate nonsurvivors, 10 were Childs C class, and eight had emergent TIPS placement. The 2-year mortality rate was 84% for non-LT candidates versus 24% for LT candidates. Median survival time for non-LT candidates was 2.6 months compared with 20 months in the LT candidates (p < 0.001). Only one death was due to a TIPS-related complication.

CONCLUSIONS

TIPS is unquestionably an advancement in the management of patients with portal hypertension complications. Non-LT candidates, compared with LT candidates, tended to be older and of a Child-Pugh C class, and they had survival rates often less than 90 days post-TIPS. Given these high mortality rates, we need to address whether TIPS is indicated in these non-LT candidates.

Authors+Show Affiliations

Section of Digestive Diseases, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

7639222

Citation

Spiess, S E., et al. "Transjugular Intrahepatic Portosystemic Shunt in Nonliver Transplant Candidates: Is It Indicated?" The American Journal of Gastroenterology, vol. 90, no. 8, 1995, pp. 1238-43.
Spiess SE, Matalon TA, Jensen DM, et al. Transjugular intrahepatic portosystemic shunt in nonliver transplant candidates: is it indicated? Am J Gastroenterol. 1995;90(8):1238-43.
Spiess, S. E., Matalon, T. A., Jensen, D. M., Rosenblate, H. J., Brunner, M. C., & Ganger, D. R. (1995). Transjugular intrahepatic portosystemic shunt in nonliver transplant candidates: is it indicated? The American Journal of Gastroenterology, 90(8), 1238-43.
Spiess SE, et al. Transjugular Intrahepatic Portosystemic Shunt in Nonliver Transplant Candidates: Is It Indicated. Am J Gastroenterol. 1995;90(8):1238-43. PubMed PMID: 7639222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transjugular intrahepatic portosystemic shunt in nonliver transplant candidates: is it indicated? AU - Spiess,S E, AU - Matalon,T A, AU - Jensen,D M, AU - Rosenblate,H J, AU - Brunner,M C, AU - Ganger,D R, PY - 1995/8/1/pubmed PY - 1995/8/1/medline PY - 1995/8/1/entrez SP - 1238 EP - 43 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 90 IS - 8 N2 - BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of severe portal hypertension complications. Liver transplantation (LT) candidacy has not been a prerequisite to TIPS placement in some medical centers. OBJECTIVES: To investigate the outcome and survival of non-LT candidates after TIPS. METHODS: From November 1991 to February 1994, all patients referred for TIPS placement were evaluated for LT candidacy. Exclusions for LT included: age (> 70 yr), other significant medical conditions, or noncompliance. Indications for TIPS included refractory variceal bleeding during an acute bleed, recurrent bleeding after more than or equal to four sessions of sclerotherapy, or refractory ascites. RESULTS: Sixty patients received TIPS. Nineteen were considered non-LT candidates. Over a 2-yr follow-up, 14 of these non-LT candidates did not survive. Their median age was 63.5 compared with 56.5 yr for LT candidate nonsurvivors (p < 0.05). Among the 14 non-LT candidate nonsurvivors, 10 were Childs C class, and eight had emergent TIPS placement. The 2-year mortality rate was 84% for non-LT candidates versus 24% for LT candidates. Median survival time for non-LT candidates was 2.6 months compared with 20 months in the LT candidates (p < 0.001). Only one death was due to a TIPS-related complication. CONCLUSIONS: TIPS is unquestionably an advancement in the management of patients with portal hypertension complications. Non-LT candidates, compared with LT candidates, tended to be older and of a Child-Pugh C class, and they had survival rates often less than 90 days post-TIPS. Given these high mortality rates, we need to address whether TIPS is indicated in these non-LT candidates. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/7639222/Transjugular_intrahepatic_portosystemic_shunt_in_nonliver_transplant_candidates:_is_it_indicated L2 - https://medlineplus.gov/gastrointestinalbleeding.html DB - PRIME DP - Unbound Medicine ER -