title: Differences in long-term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed.
abstract: OBJECTIVE
  To compare the survival after transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites and variceal bleed, and to identify the factors predictive of survival.
  
  
  METHODS
  Single tertiary center, retrospective-prospective study. Chart review was performed on all patients who underwent TIPS between 1993 and 2000 and prospective follow-up to determine survival. Pre- and post-TIPS clinical parameters were compared and Kaplan-Meier analysis was applied to compare the survival of both groups. Cox regression was used to identify predictors of survival after TIPS.
  
  
  RESULTS
  A total of 163 patients were included, 62 with refractory ascites and 101 with variceal bleed. Both groups had similar age (48.2 vs 48.9 year; P = 0.65) and consisted of predominantly Caucasians (51%) and Mexican-Americans (39%). More than 75% had chronic hepatitis C, alcoholic liver disease or both. Overall, the median survival was significantly better for variceal bleed (2 years) compared with refractory ascites (6 months) (P < 0.001). This survival advantage persisted in patients with Mayo risk score greater than 1.17. Transjugular intrahepatic portosystemic shunt improved severe ascites in 45% of patients (P = 0.03). Mayo risk score was highly predictive of survival after TIPS with a hazard ratio of 2.3, followed by Child-Pugh score, creatinine, albumin and ethnicity, with better survival among Mexican-Americans. Shunt dysfunction (31%) and hepatic encephalopathy (27%) were the most common complications of TIPS.
  
  
  CONCLUSIONS
  Patients who received TIPS for variceal bleed had significantly longer survival compared with those for refractory ascites. Mexican-Americans had an improved long-term survival compared with Caucasians. The reason for this ethnic difference in survival is unclear and warrants further prospective evaluation.
authors.affiliation: Department of Internal Medicine, The University of Texas Medical Branch of Galveston, Texas, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Membreno
authors.forename: Arturo L
authors.initials: AL
authors.lastname: Baez
authors.forename: Reka
authors.initials: R
authors.lastname: Pandula
authors.forename: Eric
authors.initials: E
authors.lastname: Walser
authors.forename: Daryl T-Y
authors.initials: DT
authors.lastname: Lau
mesh_terms: D001201:Ascites / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality*; D011184:Postoperative Period; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome