title: Impact of transjugular intrahepatic portosystemic shunt creation on intermediate-term model for end-stage liver disease score progression.
abstract: OBJECTIVE
  To assess the impact of transjugular intrahepatic portosystemic shunt (TIPS) creation on Model for End-stage Liver Disease (MELD) score temporal progression in patients with liver cirrhosis.
  
  
  METHODS
  In this single-institution retrospective study, 256 consecutive patients who underwent TIPS creation between 1999 and 2013 were identified for potential investigation. Inclusion criteria for analysis consisted of at least 6 months of post-TIPS clinical follow-up with available lab values at 1, 3, 6, and, if available, 12 months post-TIPS for MELD score calculation. Patients who were lost to follow-up or expired within 6 months, lacked sufficient lab follow-up, or underwent liver transplantation within 6 months of TIPS were excluded from the study cohort. Within-patient variance in MELD score was assessed using repeated-measures analysis of variance.
  
  
  RESULTS
  Sixty-six patients met criteria for study inclusion. TIPS were created for variceal hemorrhage (n = 26) or ascites, hydrothorax, or portal vein thrombosis (n = 40). Hemodynamic success rate was 97% (64/66) and median portosystemic pressure gradient reduction was 13 mm Hg. Median baseline MELD score was 14 (range 7-26). Low MELD scores (≤ 10, n = 16) increased in sequential scores over 1-year follow-up (median increase +3.5), intermediate MELD scores (11-18, n = 34) showed general stability in successive scores over 1-year follow-up (median increase +1), and high MELD scores (≥ 19, n = 16) decreased in serial scores over 1-year follow-up (median decrease -4); these trends are compatible with published MELD progression tendencies in cirrhotic patients without TIPS. However, the MELD score changes were not statistically significant (P = .172) on within-subject comparison.
  
  
  CONCLUSIONS
  Among patients with liver cirrhosis who recover from the procedure, TIPS creation does not alter the natural MELD score evolution during intermediate term follow-up, and as such does not significantly alter liver transplant candidacy.
authors.affiliation: University of Illinois College of Medicine, Chicago, Illinois, United States.
authors.forename: L C
authors.initials: LC
authors.lastname: Casadaban
authors.affiliation: University of Illinois College of Medicine, Chicago, Illinois, United States.
authors.forename: M G
authors.initials: MG
authors.lastname: Gabra
authors.affiliation: University of Illinois College of Medicine, Chicago, Illinois, United States.
authors.forename: A
authors.initials: A
authors.lastname: Parvinian
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States.
authors.forename: J
authors.initials: J
authors.lastname: Minocha
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States.
authors.forename: M G
authors.initials: MG
authors.lastname: Knuttinen
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States.
authors.forename: J T
authors.initials: JT
authors.lastname: Bui
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States. Electronic address: rgaba@uic.edu.
authors.forename: R C
authors.initials: RC
authors.lastname: Gaba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008099:Liver / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical