title: Transjugular intrahepatic portosystemic shunt: Indications, complications, survival and its use as a bridging therapy to liver transplant in Western Australia.
abstract: BACKGROUND
  Insertion of transjugular intrahepatic portosystemic shunt (TIPS) is an established therapeutic option to treat the complications of portal hypertension. The purpose of this study is to review the experience of a single Australian institute with TIPS and evaluation of result to emphasize the indication, aetiology of portal hypertension, prognostic factors, complications and survival. Use of TIPS as a bridge to liver transplantation was also analysed.
  
  
  METHODS
  A retrospective cohort study of patients treated with TIPS at The Western Australian Liver Transplant Unit, Sir Charles Gairdner Hospital, over a period of 12 years. Kaplan-Meier method was used for survival analysis and cox-regression analysis was used to analyse the predictors of survival.
  
  
  RESULTS
  Fifty-three patients underwent TIPS between January 2000 and March 2012. The cumulative survival at 1 month, 1 year and 5 years was 90%, 70.9% and 43.9%, respectively. The predictors of survival were indication (variceal bleeding versus ascites, hazard ratio 3.19, CI 95%: 1.164-8.794, P = 0.024) and Model of End Stage Liver Disease score (Hazard ratio 2.513, CI 95%: 1.087-5.810, P = 0.031). Patients who underwent TIPS as a bridge to liver transplant had a 5-year survival of 71% that is comparable to the overall survival of Western Australian liver transplant unit.
  
  
  CONCLUSIONS
  Transjugular intrahepatic portosystemic shunt is a safe and effective method of treatment of complications of portal hypertension. TIPS can be safely used as a bridging therapy to liver transplant. Despite small number of TIPS being performed at our institute, our technical results are comparable to the institutes with bigger number of patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: Puraskar
authors.initials: P
authors.lastname: Pateria
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.|School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia.
authors.forename: Gary P
authors.initials: GP
authors.lastname: Jeffrey
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.|School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Garas
authors.affiliation: Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Tibballs
authors.affiliation: Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Ferguson
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia.|Department of Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: Luc
authors.initials: L
authors.lastname: Delriviere
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia.
authors.forename: Yi
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.|School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia.
authors.forename: Leon A
authors.initials: LA
authors.lastname: Adams
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.|School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia.
authors.forename: Gerry
authors.initials: G
authors.lastname: MacQuillan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014904:Western Australia
chemical_list: D015415:Biomarkers
keywords: ascites; encephalopathy; liver transplantation; oesophageal varices; porto-systemic shunt