Document Detail


Prosthetic H-Graft Portacaval Shunts vs Transjugular Intrahepatic Portasystemic Stent Shunts: 18-Year Follow-Up of a Randomized Trial.
MedLine Citation:
PMID:  22463885     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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:
Alexander S Rosemurgy; Heather A Frohman; Anthony F Teta; Kenneth Luberice; Sharona B Ross
Related Documents :
10603115 - Neurodevelopmental outcome of children initiating peritoneal dialysis in early infancy.
15151265 - Loss of captopril-bound fe by end-stage renal failure patients during hemodialysis.
10570095 - Sustained reduction of hyperhomocysteinaemia with folic acid supplementation in predial...
19948875 - Enterococcal peritonitis in australian peritoneal dialysis patients: predictors, treatm...
11269785 - Percutaneous balloon mitral commissurotomy during pregnancy.
1822105 - A review of 80 endometrial resections for menorrhagia.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  214     ISSN:  1879-1190     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  445-53     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Affiliation:
Tampa General Medical Group, Tampa General Hospital, Tampa, FL.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Improved long-term survival of dialysis patients after near-total parathyroidectomy.
Next Document:  Five-year outcomes after oxandrolone administration in severely burned children: a randomized clinic...