PLoS ONE (Jan 2018)

Transjugular intrahepatic portosystemic shunts (TIPS) for the prevention of variceal re-bleeding - A two decades experience.

  • Theresa Bucsics,
  • Maria Schoder,
  • Magdalena Diermayr,
  • Maria Feldner-Busztin,
  • Nicolas Goeschl,
  • David Bauer,
  • Philipp Schwabl,
  • Mattias Mandorfer,
  • Bernhard Angermayr,
  • Manfred Cejna,
  • Arnulf Ferlitsch,
  • Wolfgang Sieghart,
  • Michael Trauner,
  • Markus Peck-Radosavljevic,
  • Josef Karner,
  • Franz Karnel,
  • Thomas Reiberger

DOI
https://doi.org/10.1371/journal.pone.0189414
Journal volume & issue
Vol. 13, no. 1
p. e0189414

Abstract

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Transjugular intrahepatic portosystemic shunts (TIPS) are used in patients with cirrhosis for the prevention of variceal rebleeding.We retrospectively evaluated re-bleeding rate, patency, mortality, and transplant-free survival (TFS) in cirrhotic patients receiving TIPS implantation for variceal bleeding between 1994-2014.286 patients received TIPS (n = 119 bare metal stents, n = 167 polytetrafluorethylene (PTFE)-covered stents) for prevention of variceal re-bleeding. Mean age was 55.1 years, median MELD was 11.8, and the main etiology of cirrhosis was alcoholic liver disease (70%). Median follow-up was 821 days. 67 patients (23%) experienced at least one re-bleeding event. Patients with PTFE-TIPS were at significantly lower risk for variceal re-bleeding than patients with bare metal stents (14% vs. 37%, OR:0.259; p<0.001) and had less need for stent revision (21% vs. 37%; p = 0.024). Patients with PTFE stent grafts showed lower mortality than patients with bare stents after 1 year (19% vs. 31%, p = 0.020) and 2 years (29% vs. 40%; p = 0.041) after TIPS implantation. Occurrence of hepatic encephalopathy after TIPS was similar between groups (20% vs. 24%, p = 0.449).PTFE-TIPS were more effective at preventing variceal re-bleeding than bare metal stents due to better patency. Since this tended to translate in improved survival, only covered stents should be implemented for bleeding prophylaxis when TIPS is indicated.