title: Prosthetic H-graft portacaval shunts vs transjugular intrahepatic portasystemic stent shunts: 18-year follow-up of a randomized trial.
abstract: 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.
  
  
  METHODS
  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.affiliation: Tampa General Medical Group, Tampa General Hospital, Tampa, FL 33606, USA. arosemurgy@tgh.org
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
authors.forename: Heather A
authors.initials: HA
authors.lastname: Frohman
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Teta
authors.forename: Kenneth
authors.initials: K
authors.lastname: Luberice
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods* / Q000401:mortality; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome