Document Detail


Transjugular intrahepatic portosystemic shunt in nonliver transplant candidates: is it indicated?
MedLine Citation:
PMID:  7639222     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
S E Spiess; T A Matalon; D M Jensen; H J Rosenblate; M C Brunner; D R Ganger
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  90     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  1995 Aug 
Date Detail:
Created Date:  1995-09-08     Completed Date:  1995-09-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1238-43     Citation Subset:  IM    
Affiliation:
Section of Digestive Diseases, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois, USA.
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MeSH Terms
Descriptor/Qualifier:
Esophageal and Gastric Varices / etiology,  mortality,  surgery*
Female
Follow-Up Studies
Gastrointestinal Hemorrhage / etiology,  mortality,  surgery*
Humans
Hypertension, Portal / complications,  mortality,  surgery*
Life Tables
Liver Transplantation* / mortality
Male
Middle Aged
Patient Selection
Portasystemic Shunt, Surgical* / methods,  mortality
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome

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


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