Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data.
OBJECTIVE
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.
Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
Hyung Ki
HK
Kim
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Yoon Jun
YJ
Kim
Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea.
Woo Jin
WJ
Chung
Department of Internal Medicine, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea.
Soon Sun
SS
Kim
Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
Jae Jun
JJ
Shim
Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea.
Moon Seok
MS
Choi
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Do Young
DY
Kim
Department of Internal Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea.
Dae Won
DW
Jun
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Soon Ho
SH
Um
Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.
Sung Jae
SJ
Park
Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea.
Hyun Young
HY
Woo
Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea.
Young Kul
YK
Jung
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Soon Koo
SK
Baik
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Moon Young
MY
Kim
Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea.
Soo Young
SY
Park
Department of Radiology, Soonchunhyang University College of Medicine, Bucheon, Korea.
Jae Myeong
JM
Lee
Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
Young Seok
YS
Kim
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D058625:End Stage Liver Disease / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006501:Hepatic Encephalopathy / Q000209:etiology; D006785:Hospitals, University; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
Liver cirrhosis; Portal hypertension; Transjugular intrahepatic portosystemic shunt