In this study, researchers from Dartmouth-Hitchcock Medical Center, Lebanon, sought to determine long-term survival, shunt patency, and quality of life in patients after creation of a transjugular intrahepatic portosystemic shunt (TIPS).
The researchers followed-up 103 patients who underwent TIPS for a mean of 20 months.
They analyzed data on long-term survival, shunt patency, as well as correlation with Child-Pugh classification and indications for TIPS.
The team used the Rand 36-Item Health Survey 1.0 to assess quality of life over time.
|Health scores after TIPS in all 9 categories were higher than those pre-procedure.|
|American Journal of Roentgenology|
The researchers determined the cumulative survival rate to be 68%, 60%, 50%, 41%, and 41% for years 1 to 5, respectively.
They found cumulative survival to be significantly higher for patients classified as Child-Pugh class A or B versus those classified as class C.
However, no significant difference in survival rates was found between patients with Child-Pugh A and those with Child-Pugh B.
Cumulative survival was also higher for patients with the original indication of variceal bleeding, compared with refractory ascites or hydrothorax.
The researchers also identified the cumulative primary patency rate to be 50%, 34%, 21%, 13%, and 13% at years 1 to 5, respectively, with an assisted patency rate of 80%, 61%, 46%, 42%, and 36%.
Cumulative secondary patency rate was 85%, 64%, 55%, 55%, and 55% at years 1 to 5.
Mean follow-up time in the 33 patients, who completed quality-of-life questionnaires with 1 follow-up, was 17 months.
The team found that health scores after TIPS in all 9 categories were higher than those pre-procedure. These were statistically significant in 4 categories.
The second follow-up was completed by 21 patients, 31 months after TIPS creation.
Both follow-up scores were higher than those before TIPS.
The team found scores in 5 categories were further improved at the second surveillance, however, those in the other 4 categories were slightly worse.
Dr Zhen Zhuang's team concluded, "TIPS has positive efficacy both for controlling bleeding or ascites and for improving the quality of life".
"The precise impact of TIPS on long-term survival, however, requires further clarification".