Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data

Hyung K.i. Kim; Yoon J.un Kim; Woo J.in Chung; Soon S.un Kim; Jae J.un Shim; Moon S.eok Choi; Do Y.oung Kim; Dae W.on Jun; Soon H.o. Um; Sung J.ae Park; Hyun Y.oung Woo; Young K.ul Jung; Soon K.oo Baik; Moon Y.oung Kim; Soo Y.oung Park; Jae M.yeong Lee; Young S.eok Kim

doi:10.3350/cmh.2014.20.1.18

Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data

Hyung K.i. Kim, Yoon J.un Kim, Woo J.in Chung, Soon S.un Kim, Jae J.un Shim, Moon S.eok Choi, Do Y.oung Kim, Dae W.on Jun, Soon H.o. Um, Sung J.ae Park, Hyun Y.oung Woo, Young K.ul Jung, Soon K.oo Baik, Moon Y.oung Kim, Soo Y.oung Park, Jae M.yeong Lee, Young S.eok Kim

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23 Citations (Scopus)

Abstract

BACKGROUND/AIMS: This retrospective study assessed the clinical outcome of a transjugular intrahepatic portosystemic shunt (TIPS) procedure for managing portal hypertension in Koreans with liver cirrhosis.

METHODS: Between January 2003 and July 2013, 230 patients received a TIPS in 13 university-based hospitals.

RESULTS: Of the 229 (99.6%) patients who successfully underwent TIPS placement, 142 received a TIPS for variceal bleeding, 84 for refractory ascites, and 3 for other indications. The follow-up period was 24.9 ± 30.2 months (mean ± SD), 74.7% of the stents were covered, and the primary patency rate at the 1-year follow-up was 78.7%. Hemorrhage occurred in 30 (21.1%) patients during follow-up; of these, 28 (93.3%) cases of rebleeding were associated with stent dysfunction. Fifty-four (23.6%) patients developed new hepatic encephalopathy, and most of these patients were successfully managed conservatively. The cumulative survival rates at 1, 6, 12, and 24 months were 87.5%, 75.0%, 66.8%, and 57.5%, respectively. A high Model for End-Stage Liver Disease (MELD) score was significantly associated with the risk of death within the first month after receiving a TIPS (P=0.018). Old age (P<0.001), indication for a TIPS (ascites vs. bleeding, P=0.005), low serum albumin (P<0.001), and high MELD score (P=0.006) were associated with overall mortality.

CONCLUSIONS: A high MELD score was found to be significantly associated with early and overall mortality rate in TIPS patients. Determining the appropriate indication is warranted to improve survival in these patients.

Original language	English
Pages (from-to)	18-27
Number of pages	10
Journal	Clinical and Molecular Hepatology
Volume	20
Issue number	1
DOIs	https://doi.org/10.3350/cmh.2014.20.1.18
Publication status	Published - 2014 Mar 1
Externally published	Yes

Keywords

Liver cirrhosis
Portal hypertension
Transjugular intrahepatic portosystemic shunt

ASJC Scopus subject areas

Hepatology
Molecular Biology

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10.3350/cmh.2014.20.1.18

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Kim, H. K. I., Kim, Y. J. U., Chung, W. J. I., Kim, S. S. U., Shim, J. J. U., Choi, M. S. E., Kim, D. Y. O., Jun, D. W. O., Um, S. H. O., Park, S. J. A., Woo, H. Y. O., Jung, Y. K. U., Baik, S. K. O., Kim, M. Y. O., Park, S. Y. O., Lee, J. M. Y., & Kim, Y. S. E. (2014). Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data. Clinical and Molecular Hepatology, 20(1), 18-27. https://doi.org/10.3350/cmh.2014.20.1.18

Kim, HKI, Kim, YJU, Chung, WJI, Kim, SSU, Shim, JJU, Choi, MSE, Kim, DYO, Jun, DWO, Um, SHO, Park, SJA, Woo, HYO, Jung, YKU, Baik, SKO, Kim, MYO, Park, SYO, Lee, JMY & Kim, YSE 2014, 'Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data', Clinical and Molecular Hepatology, vol. 20, no. 1, pp. 18-27. https://doi.org/10.3350/cmh.2014.20.1.18

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title = "Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data",

abstract = "BACKGROUND/AIMS: This retrospective study assessed the clinical outcome of a transjugular intrahepatic portosystemic shunt (TIPS) procedure for managing portal hypertension in Koreans with liver cirrhosis.METHODS: Between January 2003 and July 2013, 230 patients received a TIPS in 13 university-based hospitals.RESULTS: Of the 229 (99.6%) patients who successfully underwent TIPS placement, 142 received a TIPS for variceal bleeding, 84 for refractory ascites, and 3 for other indications. The follow-up period was 24.9 ± 30.2 months (mean ± SD), 74.7% of the stents were covered, and the primary patency rate at the 1-year follow-up was 78.7%. Hemorrhage occurred in 30 (21.1%) patients during follow-up; of these, 28 (93.3%) cases of rebleeding were associated with stent dysfunction. Fifty-four (23.6%) patients developed new hepatic encephalopathy, and most of these patients were successfully managed conservatively. The cumulative survival rates at 1, 6, 12, and 24 months were 87.5%, 75.0%, 66.8%, and 57.5%, respectively. A high Model for End-Stage Liver Disease (MELD) score was significantly associated with the risk of death within the first month after receiving a TIPS (P=0.018). Old age (P<0.001), indication for a TIPS (ascites vs. bleeding, P=0.005), low serum albumin (P<0.001), and high MELD score (P=0.006) were associated with overall mortality.CONCLUSIONS: A high MELD score was found to be significantly associated with early and overall mortality rate in TIPS patients. Determining the appropriate indication is warranted to improve survival in these patients.",

keywords = "Liver cirrhosis, Portal hypertension, Transjugular intrahepatic portosystemic shunt",

author = "Kim, {Hyung K.i.} and Kim, {Yoon J.un} and Chung, {Woo J.in} and Kim, {Soon S.un} and Shim, {Jae J.un} and Choi, {Moon S.eok} and Kim, {Do Y.oung} and Jun, {Dae W.on} and Um, {Soon H.o.} and Park, {Sung J.ae} and Woo, {Hyun Y.oung} and Jung, {Young K.ul} and Baik, {Soon K.oo} and Kim, {Moon Y.oung} and Park, {Soo Y.oung} and Lee, {Jae M.yeong} and Kim, {Young S.eok}",

year = "2014",

month = mar,

day = "1",

doi = "10.3350/cmh.2014.20.1.18",

language = "English",

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pages = "18--27",

journal = "Clinical and Molecular Hepatology",

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publisher = "Korean Association for the Study of the Liver",

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TY - JOUR

T1 - Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension

T2 - Korean multicenter real-practice data

AU - Kim, Hyung K.i.

AU - Kim, Yoon J.un

AU - Chung, Woo J.in

AU - Kim, Soon S.un

AU - Shim, Jae J.un

AU - Choi, Moon S.eok

AU - Kim, Do Y.oung

AU - Jun, Dae W.on

AU - Um, Soon H.o.

AU - Park, Sung J.ae

AU - Woo, Hyun Y.oung

AU - Jung, Young K.ul

AU - Baik, Soon K.oo

AU - Kim, Moon Y.oung

AU - Park, Soo Y.oung

AU - Lee, Jae M.yeong

AU - Kim, Young S.eok

PY - 2014/3/1

Y1 - 2014/3/1

N2 - BACKGROUND/AIMS: This retrospective study assessed the clinical outcome of a transjugular intrahepatic portosystemic shunt (TIPS) procedure for managing portal hypertension in Koreans with liver cirrhosis.METHODS: Between January 2003 and July 2013, 230 patients received a TIPS in 13 university-based hospitals.RESULTS: Of the 229 (99.6%) patients who successfully underwent TIPS placement, 142 received a TIPS for variceal bleeding, 84 for refractory ascites, and 3 for other indications. The follow-up period was 24.9 ± 30.2 months (mean ± SD), 74.7% of the stents were covered, and the primary patency rate at the 1-year follow-up was 78.7%. Hemorrhage occurred in 30 (21.1%) patients during follow-up; of these, 28 (93.3%) cases of rebleeding were associated with stent dysfunction. Fifty-four (23.6%) patients developed new hepatic encephalopathy, and most of these patients were successfully managed conservatively. The cumulative survival rates at 1, 6, 12, and 24 months were 87.5%, 75.0%, 66.8%, and 57.5%, respectively. A high Model for End-Stage Liver Disease (MELD) score was significantly associated with the risk of death within the first month after receiving a TIPS (P=0.018). Old age (P<0.001), indication for a TIPS (ascites vs. bleeding, P=0.005), low serum albumin (P<0.001), and high MELD score (P=0.006) were associated with overall mortality.CONCLUSIONS: A high MELD score was found to be significantly associated with early and overall mortality rate in TIPS patients. Determining the appropriate indication is warranted to improve survival in these patients.

AB - BACKGROUND/AIMS: This retrospective study assessed the clinical outcome of a transjugular intrahepatic portosystemic shunt (TIPS) procedure for managing portal hypertension in Koreans with liver cirrhosis.METHODS: Between January 2003 and July 2013, 230 patients received a TIPS in 13 university-based hospitals.RESULTS: Of the 229 (99.6%) patients who successfully underwent TIPS placement, 142 received a TIPS for variceal bleeding, 84 for refractory ascites, and 3 for other indications. The follow-up period was 24.9 ± 30.2 months (mean ± SD), 74.7% of the stents were covered, and the primary patency rate at the 1-year follow-up was 78.7%. Hemorrhage occurred in 30 (21.1%) patients during follow-up; of these, 28 (93.3%) cases of rebleeding were associated with stent dysfunction. Fifty-four (23.6%) patients developed new hepatic encephalopathy, and most of these patients were successfully managed conservatively. The cumulative survival rates at 1, 6, 12, and 24 months were 87.5%, 75.0%, 66.8%, and 57.5%, respectively. A high Model for End-Stage Liver Disease (MELD) score was significantly associated with the risk of death within the first month after receiving a TIPS (P=0.018). Old age (P<0.001), indication for a TIPS (ascites vs. bleeding, P=0.005), low serum albumin (P<0.001), and high MELD score (P=0.006) were associated with overall mortality.CONCLUSIONS: A high MELD score was found to be significantly associated with early and overall mortality rate in TIPS patients. Determining the appropriate indication is warranted to improve survival in these patients.

KW - Liver cirrhosis

KW - Portal hypertension

KW - Transjugular intrahepatic portosystemic shunt

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JF - Clinical and Molecular Hepatology

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Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data

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