title: Association Between Transjugular Intrahepatic Portosystemic Shunt and Survival in Patients With Cirrhosis.
abstract: OBJECTIVE
  A transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of refractory ascites and variceal bleeding. However, it is unclear whether a TIPS affects long-term survival. We investigated whether a TIPS is associated with survival in patients with cirrhosis awaiting liver transplantation.
  
  
  METHODS
  By using the United Network for Organ Sharing registries from 2002 to 2013, we followed up a cohort of transplant-naive adults with cirrhosis (N = 97,063) from the time of transplant listing until the time of death or transplantation. We used Cox proportional hazards and competing-risks analyses to compare these primary outcomes between patients with a TIPS (n = 7475; 7.7%) and without a TIPS (n = 89,588; 92.3%) at the time of listing, adjusting for baseline characteristics.
  
  
  RESULTS
  During an average follow-up period of 1.61 years, 23,305 (24%) patients died before undergoing transplantation, 47,563 (49%) underwent transplantation, and the remaining 26,195 (27%) still were alive without having received a liver transplant. Compared with patients without a TIPS, patients with a TIPS had a lower risk of death (adjusted subhazard ratio, 0.95; 95% confidence interval, 0.9-0.99), transplantation (adjusted subhazard ratio, 0.92, 95% confidence interval, 0.88-0.95), or the combined outcome of death or transplantation (adjusted hazard ratio, 0.85; 95% confidence interval, 0.83-0.88).
  
  
  CONCLUSIONS
  Among patients with cirrhosis awaiting liver transplantation, patients with a TIPS had a lower mortality rate than patients without a TIPS.
authors.affiliation: Research and Development, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington.
authors.forename: Kristin
authors.initials: K
authors.lastname: Berry
authors.affiliation: Division of Internal Medicine, Department of Medicine, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington.
authors.forename: Robert
authors.initials: R
authors.lastname: Lerrigo
authors.affiliation: Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington.
authors.forename: Iris W
authors.initials: IW
authors.lastname: Liou
authors.affiliation: Research and Development, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington; Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington. Electronic address: georgei@medicine.washington.edu.
authors.forename: George N
authors.initials: GN
authors.lastname: Ioannou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Cirrhosis; Hepatic Hydrothorax; Hepatocellular Carcinoma; Hepatorenal Syndrome; Liver Transplantation; MELD Score; Mortality; TIPS; Transjugular Intrahepatic Portosystemic Shunt