Effect of transjugular intrahepatic portosystemic shunt on quality of life.
OBJECTIVE
The objective of this study was to determine the effect of the transjugular intrahepatic portosystemic shunt (TIPS) procedure on the quality of life.


METHODS
Data were collected on 99 patients who underwent the TIPS procedure between September 1991 and September 1995. Quality of life was assessed by the Karnofsky scale before and at intervals after the procedure. Procedure-related complications and other aspects of the patients' overall well-being, as reflected in liver and kidney function and nutritional status, were reviewed immediately before and after TIPS creation. Finally, mortality and TIPS patency rates were tabulated.


RESULTS
We observed significantly improved quality of life. The quality of life remained significantly improved throughout the 24-month follow-up period. During the 1- to 3-month interval after the TIPS procedure, we observed in patients a significant decrease in blood urea nitrogen and an increase in albumin and bilirubin. During this period, patients had no significant change in liver enzymes, prothrombin time, ammonia, or creatinine. Complications of the TIPS procedure included a 30% incidence of new or worsened encephalopathy and a 15% incidence of other severe complications (intraperitoneal hemorrhage, severe accelerated liver failure). The procedure-related death rate was 5%. Longer term follow-up showed an overall sustained decrease in blood urea nitrogen, an increase in albumin, and a return of bilirubin to the pre-TIPS levels or below.


CONCLUSIONS
For patients who survive longer than 1 month, TIPS results in an overall, sustained improvement in the quality of life. Improved quality of life may result from a low incidence of repeat variceal bleeding, decreased ascites, and improved nutritional status.
Nazarian
G K
GK
Department of Radiology, University of Minnesota Hospital and Clinic, Minneapolis 55455-0392, USA.
Ferral
H
H
Bjarnason
H
H
Castañeda-Zúñiga
W R
WR
Rank
J M
JM
Bernadas
C A
CA
Hunter
D W
DW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality; D011788:Quality of Life; D015996:Survival Rate