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Long-Term Results and Quality of Life in Patients Treated with Transjugular Intrahepatic Portosystemic Shunts

¹ All authors: Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756.

OBJECTIVE. The purpose of our study was to determine long-term survival, shunt patency, and quality of life in patients after creation of a transjugular intrahepatic portosystemic shunt (TIPS).

MATERIALS AND METHODS. We followed up 103 patients who underwent TIPS for a mean of 20.10 ± 25.58 months (range, 1 day-92 months). Various statistical methods were used to analyze long-term survival, shunt patency, and correlation with Child-Pugh classification and indications for TIPS. The Rand 36-Item Health Survey 1.0 was used to assess quality of life over time.

RESULTS. The cumulative survival rate was 68%, 60%, 50%, 41%, and 41% at years 1-5, respectively. The cumulative survival rate was significantly higher for patients classified as Child-Pugh class A or B versus those classified as class C (p < 0.01), as well as for patients with the original indication of variceal bleeding versus refractory ascites or hydrothorax (p < 0.01). No significant difference in survival rates was found between patients with Child-Pugh A and those with Child-Pugh B. The cumulative primary patency rate was 50%, 34%, 21%, 13%, and 13% at years 1-5, respectively, with assisted patency rate of 80%, 61%, 46%, 42%, and 36%. Cumulative secondary patency rate was 85%, 64%, 55%, 55%, and 55% at years 1-5. Mean follow-up time in 33 patients who completed quality-of-life questionnaires with one follow-up was 17.46 months. Scores after TIPS in all nine of the health categories were higher than those preprocedure with statistically significant improvement in four categories. The second follow-up was completed by 21 patients at a mean of 30.58 months after TIPS creation. Both scores after TIPS were higher than those before TIPS, and scores in five categories were further improved at the second surveillance (p < 0.0, only for health change), whereas in four categories, the scores were slightly worse.

CONCLUSION. 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.

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