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TIPS increased mortality risk among liver transplantation recipients
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LAS VEGAS — Orthotopic liver transplantation before transjugular intrahepatic portosystemic shunt creation is associated with increased mortality risk, according to data presented at the 2012 of Gastroenterology Annual Scientific Meeting.
Researchers evaluated data from patients who received transjugular intrahepatic portosystemic shunts (TIPS) between 2001 and 2011, including 27 who underwent orthotopic liver transplantation (OLT) and 56 matched controls who did not.
Patients received TIPS most frequently for refractory ascites (44.4% of patients) and bleeding esophageal varices (25.9%), and the procedure was performed a median of 53.1 months following transplantation. Investigators did not observe any significant differences between groups with regard to demographics, incidence of complications or MELD or Child-Turcotte-Pugh (CTP) scores prior to transplant.
Mortality rates were higher among patients who underwent OLT than in controls (59.2% vs. 25.0%, P=.02), and survival rates following TIPS were significantly shorter (median 64.5 days for OLT patients compared with 512.5 days among controls, P<.001). More than half of the deaths in the OLT group (58.8%) occurred within 90 days of TIPS.
No association was observed between increased mortality risk and pre-transplant MELD (RR=4.0; 95% CI, 0.6-19.7) or CTP scores (RR=0.7; 95% CI, 0.2-2.7), the presence of active bleeding (RR=2.0; 95% CI, 0.9-4.2) or portal gradient before TIPS (RR=0.3; 95% CI, 0.02-3.74).
Jose Mari Parungao
“TIPS is associated with increased mortality in patients with a prior history of liver transplant,” researcher Jose Mari Parungao, MD, a resident at Cleveland Clinic told Healio.com. “MELD scores and [CTP] scores, whether [in those receiving] transplant or non-transplant, weren’t associated with mortality risk. TIPS itself is associated with the risk, more than anything else.”
For more information:
Parungao JM. P791: Transjugular Intrahepatic Portosystemic Shunts (TIPS) Is Associated With Increased Mortality in Patients After Orthotopic Liver Transplantation (OLT). Presented at: the 2012 American College of Gastroenterology Annual Scientific Meeting; Oct. 19-24; Las Vegas.