title: Transjugular Intrahepatic Porto-Systemic Shunt in Patients with Liver Cirrhosis and Model for End-Stage Liver Disease ≥15.
abstract: It is not known whether transjugular intrahepatic porto-systemic shunt (TIPS) is safe in patients with advanced liver cirrhosis. The aim of our study was to evaluate the impact of TIPS on transplant-free survival in patients with liver cirrhosis and MELD score ≥15.
  
  
  
  All adult patients who underwent TIPS at our institution between 2004 and 2011 were identified (N = 470). A total of 144 patients had MELD ≥15 at the time of TIPS. These patients were matched 1:1 to patients with liver cirrhosis who did not undergo TIPS based on age and MELD score using the greedy algorithm. Patients were followed up until time of death or liver transplantation. Kaplan-Meier curves and log-rank tests were used to test for differences in survival outcome between the two groups.
  
  
  
  A total of 288 patients with liver cirrhosis were included, of whom 144 underwent TIPS and 144 did not. The two groups were matched based on age and MELD score and were comparable with regard to gender and ethnicity. Mean MELD and Child-Pugh scores in the study population were 20.9 ± 6.5 and 10.5 ± 1.8, respectively. The most common indication for TIPS was varices (49 %), followed by refractory ascites (42 %). In the first 2 months post-TIPS, there was increased mortality or liver transplantation in patients who had TIPS compared to those who did not, but this did not reach statistical significance (p = 0.07). However, after 2 months, TIPS is associated with 56 % lower risk of dying or needing liver transplantation (p < 0.01) than cirrhotic patients who did not undergo TIPS.
  
  
  
  In patients with liver cirrhosis and MELD ≥15, TIPS might improve transplant-free survival for patients who live for at least 2 months after the procedure.
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mona
authors.initials: M
authors.lastname: Ascha
authors.affiliation: Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Hanouneh
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mustafa
authors.initials: M
authors.lastname: S Ascha
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Zein
authors.affiliation: Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sands
authors.affiliation: Department of Quantitative Health Science, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Minnesota Gastroenterology, P.A., P.O. Box 14909, Minneapolis, MN, 55414, USA. ibrahim.hanouneh@mngastro.com.
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Hanouneh
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000601:surgery*; D058625:End Stage Liver Disease; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Cirrhosis; High MELD; MELD; Outcomes; TIPS