Introduction The transjugular intrahepatic portosystemic shunt (TIPSS) is an important intervention in the management of refractory ascites and variceal bleeding. The MELD score was originally developed to predict 3 month mortality post-TIPSS and can been used to risk-stratify patients for the procedure . We present a large single centre series of patients undergoing TIPSS for all indications at a tertiary hepatology transplant centre. The aim was to assess the impact of different clinical parameters on post-TIPSS survival, including aetiology of the underlying liver disease and indication for TIPSS.
Method All patients receiving a TIPSS for all indications between January 2010 and December 2015 at Leeds Teaching Hospitals NHS Trust were included. Demographics, indication for TIPSS, aetiology of underlying liver disease, MELD score, previously documented hepatic encephalopathy and ischaemic heart disease were retrieved from electronic patient records. Post-TIPSS survival was recorded, along with complications including hepatic encephalopathy and need for vascular re-intervention.
Results Among 130 patients (65% male with mean age 55, range 20–77), 86 (66%) received a TIPSS for refractory ascites, 27 (21%) for acute refractory variceal bleeding, 6 (5%) for hepatic hydrothorax, 7 (5%) for recurrent variceal bleeding and 4 (3%) for other indications. Post-TIPSS hepatic encephalopathy was successfully managed medically in 26 patients (20%) and required TIPSS reduction in 5 patients (4%).
The median overall survival post-TIPSS was 52 months and 3 month mortality was 15%. Univariate analysis demonstrated that the 3 month mortality for patients with refractory ascites was 8% and for those with acute variceal bleeding it was 15% (p=0.46). The 3 month mortality for patients with alcoholic liver disease was 7%, for non-alcoholic fatty liver disease it was 22% and for hepatitis C it was 25% (p=0.08). Multivariate logistic regression revealed that a MELD score was predictive of 3 month mortality, independent of aetiology of liver disease and indication for TIPSS. Compared to a MELD score of <10, the adjusted odds ratio for 3 month mortality was 1.9 (p=0.29) for a MELD score of 11–15 and 4.2 (p=0.04) for a MELD score of >15.
Conclusion The overall 3 month post-TIPSS mortality of 15% compares to 30% mortality in the reference case series, which may reflect patient selection and the exclusion of those with a high MELD score. This series demonstrates that MELD score remains a valid prognostic factor for 3 month mortality for both elective procedures and emergency TIPSS for refractory variceal bleeding.
. Malinchoc M, Kamath ps, Gordon FD, Peine CJ, Rank J, Ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000;31:864–71.
Disclosure of Interest None Declared