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Association Between Transjugular Intrahepatic Porto-systemic Shunt and Survival in Patients with Cirrhosis.
Clin Gastroenterol Hepatol. 2015 Jul 17;
Authors: Berry K, Lerrigo R, Liou IW, Ioannou GN
Abstract
BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of refractory ascites and variceal bleeding. However, it is unclear whether TIPS affects long-term survival. We investigated whether TIPS is associated with survival in patients with cirrhosis awaiting liver transplantation.
METHODS: Using the United Network for Organ Sharing (UNOS) registries from 2002 to 2013, we followed a cohort of transplant-naïve adults with cirrhosis (n=97,063) from the time of transplant listing until the time of death or transplantation. We used Cox proportional hazards and competing risks analyses to compare these primary outcomes between patients with TIPS (n=7,475 or 7.7%) and without TIPS (n=89,588 or 92.3%) at the time of listing, adjusting for baseline characteristics.
RESULTS: During an average follow-up of 1.61 years, 23,305 (24%) patients died before undergoing transplantation, 47,563 (49%) underwent transplantation and the remaining 26,195 (27%) were still alive without having received liver transplants. Compared to patients without a TIPS, those with a TIPS had lower risk of death (adjusted sub-hazard ratio [ASHR], 0.95, 95% confidence interval, 0.9-0.99), transplantation (ASHR, 0.92, 95% confidence interval, 0.88-0.95), or the combined outcome of death or transplantation (adjusted hazard ratio 0.85, 95% confidence interval 0.83-0.88).
CONCLUSIONS: Among patients with cirrhosis awaiting liver transplantation, those with a TIPS had lower mortality than those without a TIPS.
PMID: 26192147 [PubMed - as supplied by publisher]