Introduction Transjugular intrahepatic portosystemic shunts (TIPSS) play an important role in the management of refractory ascites, particularly in patients considered unsuitable for transplantation or in whom a low UKELD score precludes an early transplant. TIPSS carries the risk of precipitating decompensation of underlying liver disease and patients may undergo a prior liver transplant assessment in case they require salvage post-TIPSS. We present a large single centre experience of patients undergoing TIPSS for all indications at a tertiary hepatology transplant centre. The aim was to examine the outcomes of patients receiving a TIPSS and to assess the impact on subsequent liver transplantation.
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, UKELD score, and outcome of a previous liver transplant assessment were retrieved from electronic patient records. Post-TIPSS survival was recorded, along with details of subsequent liver transplantation or transplant assessment.
Results 130 patients underwent TIPSS during the study period. 67 had a pre-TIPSS transplant assessment and 42 (32%) were assessed as being suitable for a salvage transplant post-TIPSS. Of these 42 patients, alcohol was the aetiology in 29 patients (69%) and the median UKELD score was 52. Among these patients, the median survival was 37.3 months and 8 patients (19%) died within a year of the procedure; 2 died of decompensated liver disease while awaiting a suitable donor liver, 3 were too unwell for transplant due to decompensated liver disease, one patient died of an intracerebral haemorrhage, one patient died of multi-organ failure during transplant re-assessment and one patient was ineligible for transplant due to recalcitrance to alcohol after receiving a TIPSS. Within the group assessed as unsuitable for salvage transplant, the median survival was 11.3 months and the 1 year mortality was 47%. In total, 8 patients were successfully transplanted post-TIPSS; this included 4 patients who were transplant assessed post-TIPSS.
Conclusion TIPSS is a less invasive intervention to relieve refractory ascites than liver transplantation in patients who may be precluded from an early transplant due to a low UKELD score. In patients with more advanced alcohol-related liver disease, TIPSS may provide time for further improvement in synthetic function with ongoing abstinence from alcohol. Despite being assessed as suitable for salvage transplant, 19% of patients died within a year of the TIPSS procedure. This highlights the risk of decompensation post-TIPSS which may preclude subsequent liver transplant, as well as the risk of awaiting a suitable donor liver.
Disclosure of Interest None Declared
- liver transplant
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