Transjugular intrahepatic
portosystemic shunts (
TIPSs) are used to treat variceal
hemorrhage and refractory
ascites. We sought to determine factors associated with
stenosis and mortality after
TIPS placement in patients with
end-stage liver disease. This is a retrospective review of 90
TIPSs placed over a 3-year period. Demographic, clinical, and biochemical parameters were analyzed in univariate analyses to determine their association with
stenosis and death. Multivariate analyses were conducted using logistic regression and Cox proportional hazard modeling. Thirty-five
TIPSs were placed for recurrent variceal
bleeding; 14
TIPSs, for uncontrolled variceal
bleeding; 34
TIPSs, for refractory
ascites; and 7
TIPSs, for other causes. The overall mortality rate was 33%, and 18 patients died within 30 days of
TIPS placement. The 1-year
stenosis rate was 49%. Fourteen patients underwent
liver transplantation a mean of 116 +/- 143 days after
TIPS placement. Prothrombin time greater than 17 seconds, serum
creatinine level greater than 1.7 mg/dL, total
bilirubin level greater than 3 mg/dL, and uncontrolled variceal
bleeding as an indication for
TIPS placement were significant predictors of 30-day mortality. Serum
creatinine level was a predictor of 30-day mortality in individuals with recurrent variceal
hemorrhage or
ascites. Multivariate analyses showed that
creatinine level greater than 1.7 mg/dL and uncontrolled variceal
bleeding as an indication for
TIPS placement were independently associated with 30-day mortality. Individuals with both coagulopathy and
renal insufficiency had a 30-day mortality rate of 78%. Urgent placement of
TIPS was associated with an increased risk for
stenosis (hazard ratio = 4.5; 95% confidence interval, 1.9 to 10.1; P <.001), but no other clinical variables were associated with
stenosis. Uncontrolled variceal
bleeding as an indication for
TIPS placement, coagulopathy,
hyperbilirubinemia, and
renal insufficiency were associated with increased mortality in patients with
TIPSs. Individuals with both coagulopathy and
renal insufficiency had high mortality. Urgent
TIPS placement for uncontrolled variceal
bleeding was associated with
stenosis.