The role of TIPS in the management of liver transplant candidates. Issue 8 (December 2017)

• Record Type: Journal Article
• Authors: Unger, Lukas W; Stork, Theresa; Bucsics, Theresa; Rasoul-Rockenschaub, Susanne; Staufer, Katharina; Trauner, Michael; Maschke, Svenja; Pawloff, Max; Soliman, Thomas; Reiberger, Thomas; Berlakovich, Gabriela A
• Is Part Of: United European Gastroenterology journal. Volume 5:Issue 8(2017)
• Page Start: 1100
• Page End: 1107
• Publication Date: 2017-12
• Subjects: Orthotopic liver transplantation -- waiting list -- bridge to transplant -- transjugular intrahepatic portosystemic shunt -- portal hypertension; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640617704807
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) implantation is used for treatment of several complications in patients with liver cirrhosis. Recent studies have identified a survival benefit for patients on the waiting list after TIPS implantation, but the optimal time point for TIPS implantation prior to orthotopic liver transplantation (OLT) has not been established. Study: This study retrospectively assessed patients undergoing TIPS implantation before or after listing for OLT at the Medical University of Vienna. n = 98 patients with TIPS on the waiting list between January 1993 and December 2013 were identified ( n = 73 (74.5%) pre-listing TIPS, n = 25 (25.5%) post-listing TIPS). A matched control group at the time of OLT without TIPS ( n = 60) was included. Results: More patients with post-listing TIPS (28.0%, 7/25) showed clinical improvement and went off-list than patients with pre-listing TIPS (8.2%, 6/73, p = .0119). A similar proportion of patients with pre-listing TIPS (19.2%, 14/73) and post-listing TIPS (20.0%, 5/25) died on the OLT waiting list. Transplant surgery time was similar in patients with and without TIPS: 348(±13) vs. 337(±10) minutes ( p = .5139). Estimated 1-year post-transplant survival was similar across all groups (pre-listing TIPS: 76.2%, post-listing TIPS: 86.0%, no TIPS: 91.2%, log-rank p = .1506). Conclusion: TIPS should be considered in all liver transplant candidates, since it can obviate the need for OLT and optimize bridging to OLT.