Survival of patients after TIPS in the University Hospital Hradec Kralove

Czech version

Authors: Š. Šembera ¹; V. Jirkovský ²; T. Fejfar ²; V. Šafka ²; O. Renc ³; J. Raupach ³; V. Chovanec ³; Miroslav Lojík ³; A. Krajina ³; P. Hůlek ²
Authors‘ workplace: Lékařská fakulta UK Hradec Králové, děkan prof. MUDr. RNDr. Miroslav Červinka, CSc. ¹; II. interní klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc. ²; Radiologická klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Pavel Eliáš, CSc. ³
Published in: Vnitř Lék 2011; 57(12): 1038-1044
Category: 70th birthday of prof. MUDr. Petr Dítě, DrSc.

Overview

Aim:
To analyze survival of patients after TIPS (transjugular intrahepatic portosystemic shunt).

Patient sample and methodology:
Between September 1992 and August 2010, TIPS was created in 848 patients of the University Hospital Hradec Kralove. These patients were divided into groups. Survival was analyzed using Kaplan-Meier survival curves. Differences between groups were evaluated using log-rank test.

Results:
Ten percent of patients do not survive one month after TIPS, 40% of patients survive 5 years and 20% of patients survive 10 years. There were statistically significant differences between groups divided according to Child-Pugh classification (A vs B p = 0.0053; B vs. C p < 0.0001), indication for surgery [prevention of bleeding recurrence differed from refractory ascites (p = 0.0001) and the indication to stop acute bleeding (p = 0.026)]; aetiology of the liver disease [patients with alcoholic cirrhosis differed from patients with Budd-Chiari syndrome (p < 0.0001) and from patients with chronic viral hepatitis (p = 0.024)].

Conclusion:
Survival of patients after TIPS is influenced by Child-Pugh score, indication and aetiology of the liver disease.

Key words:
transjugular intrahepatic portosystemic shunt –⁠ liver disease –⁠ Child-Pugh score –⁠ indication

Sources

1. Rösch J, Henafee WN, Snow H. Transjugular portal venography and radiologic portacaval shunt: an experimental study. Radiology 1969; 92 : 1112–1114.

2. Richter GM, Palmaz JC, Nöldge G et al. The transjugular intrahepatic portosystemic stent-shunt (TIPSS): a new nonoperatice, transjugular percutaneous procedure. Radiologe 1989; 29 : 406–411.

3. Fejfar T, Jirkovský V, Vaňásek T et al. Transjugulární intrahepatální portosystémová spojka –⁠ 15 let v Hradci Králové, retrospektivní analýza 694 případů. Čes a Slov Gastroent a Hepatol 2007; 61 : 209–216.

4. Krajina A, Lojík M. TIPS technique. In: Hůlek P, Krajina A et al. Current Practice of TIPS. Hradec Králové: Olga Štambergová 2001; 56–119.

5. Moore KP, Wong F, Gines P et al. The Management of Ascites in Cirrhosis: Report on the consensus conference of the international Ascites Club. Hepatology 2003; 38 : 258–266.

6. Sanyal AJ, Genning C, Reddy KR et al. North American Study for the Treatment of Refractory Ascites Group. The North American Study for the Treatment of Refractory Ascites. Gastroenterology 2003; 124 : 634–641.

7. Rössle M, Grandt D. TIPS: an update. Best Pract Res Clin Gastroenterol 2004; 18 : 99–123.

8. Šafka V, Hůlek P, Krajina A et al. Budd--Chiari syndrome and TIPS –⁠ twelve years‘ experience. Čas Lék Čes 2005; 144 (Suppl 3): 38–42.

9. Huonker M, Schumacher YO, Ochs A et al. Cardiac function and haemodynamics in alcoholic cirrhosis and effect of the transjugular intrahepatic portosystemic stent shunt. Gut 1999; 44 : 743–748.

10. Child III CG, Turcotte JG. Surgery and portal hypertension In: Child III CG (ed.). The Liver and Portal Hypertension. Philadelphia: Saunders 1964 : 50.

11. Pugh RN, Murray-Lyon IM, Dawson JL et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60 : 646–649.

12. Angermayr B, Cejna M, Karnel F et al. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut 2003; 52 : 879–885.

13. Tzeng WS, Wu RH, Lin CY et al. Prediction of Mortality after Emergent Transjugular Intrahepatic Portosystemic Shunt Placement: Use of APACHE II, Child-Pugh and MELD Scores in Asian Patients with Refractory Variceal Hemorrhage. Korean J Radiol 2009; 10 : 481–489.

14. Štefánková J, Fejfar T, Šafka V et al. Hepatic encephalopathy after TIPS –⁠ retrospective study. Vnitř Lék 2002; 48 : 309–305.

15. Jirkovsky V, Fejfar T, Safka T et al. Influence of the Secondary Deployment of Expanded Polytetrafluoroethylene-covered Stent Grafts on Maintenance of Transjugular Intrahepatic Portosystemic Shunt Patency. J Vasc Interv Radiol 2011; 22 : 55–60.

16. Zhuanq ZW, Tenq GJ, Jeffery RJ et al. Long-Term Results and Quality of Life in Patients Treated with Transjugular Intrahepatic Portosystemic Shunts. AJR Am J Roentgenol 2002; 179 : 1597–1603.