To assess complications associated with implantation of the TIPS. Methods: 344 consecutive patients were hospitalized for decompensated cirrhosis (Child-Pugh B 60% / C 40%) from 01/2008 to 12/2012. Covered stent was implanted in 98 patients for refractory ascites or recurrent gastrointestinal bleeding. Assessment of median survival (MS) with and without TIPS, MS according to Child-Pugh score and after matching 1:1 (n = 130)
Ivacaftor supplier for age, Child-Pugh score, MELD score, presence of hepatocellular carcinoma HCC, to a control group having a first decompensation. Results: TIPS implantation was successful in 100% of rates. The mean portosystemic pressure gradient decreased
from 18.5 ± 4.5 mmHg to 5.8 ± 2.6 mmHg. MS of patients with TIPS (n = 98) was 29.4 months [22–38.6] vs. 12.9 months [10.2–18.3] without TIPS (n = 246), p = 0.0015; MS of Child-Pugh B patients with TIPS (n = 69) was 38.6 months [29.4–48.7] vs. 19.1 months [14.1–35.3] without TIPS (n = 137), p = 0.0183; MS of Child-Pugh C patients with TIPS (n = 29) was 17.4 months [10.1–25.3] vs. 8 months [6.2–11.2] without TIPS (n = 109), p = 0.22. TIPS was a prognostic variable associated with survival in univariate analysis (p = 0.015). HCC, alcoholic BAY 80-6946 datasheet hepatitis were more frequent in patients without TIPS (respectively 31% vs. 8%, p < .0001, 17% vs. 10%, p = 0.05). After matching 1:1 for age (61 ± 10), Child-Pugh score (B 66%, C 34%), MELD score (17.0 ± 4.2) and presence of HCC (9%), esophageal varices grade 2 or 3 (p = 0.003), refractory ascites (p = 0.01), an increase in the portosystemic gradient (p = 0.008) were significantly more frequent in the TIPS group. Median survival was 26 months in the TIPS group (n = 65) vs. 27 months without TIPS (n = 65),
p = 1.00. selleck products Median follow up was 12 months. Rate of infection did not differ between the 2 groups. Main complications of TIPS (recurrent encephalopathy 34%, stent dysfunction 24.5%, strangulated umbilical hernia 9%, congestive heart failure 7.5%) did not affect patient survival. Conclusion: In this series, TIPS with covered stents appears to improve the natural history of Child-Pugh B cirrhosis with recurrent decompensation. Conversely, decreasing portosystemic pressure gradient does not alter the progression of Child-Pugh C cirrhosis with prolonged decompensation. Earlier implementation of a tips should be discussed for some Child-Pugh B patients with recurrent ascites or gastrointestinal bleeding. Key Word(s): 1.