Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 18, 2017; 9(2): 99-105
Published online Jan 18, 2017. doi: 10.4254/wjh.v9.i2.99
Impact of transjugular intrahepatic porto-systemic shunt on post liver transplantation outcomes: Study based on the United Network for Organ Sharing database
Khalid Mumtaz, Sherif Metwally, Rohan M Modi, Nishi Patel, Dmitry Tumin, Anthony J Michaels, James Hanje, Ashraf El-Hinnawi, Don Hayes Jr, Sylvester M Black
Khalid Mumtaz, Anthony J Michaels, James Hanje, Wexner Medical Center, Gastroenterology, Hepatology and Nutrition Division, the Ohio State University, Columbus, OH 43210, United States
Sherif Metwally, Rohan M Modi, Nishi Patel, Don Hayes Jr, Department of Internal Medicine, the Ohio State University, Columbus, OH 43210, United States
Dmitry Tumin, Don Hayes Jr, Department of Pediatrics, the Ohio State University, Columbus, OH 43210, United States
Ashraf El-Hinnawi, Sylvester M Black, Department of Surgery, the Ohio State University, Columbus, OH 43210, United States
Don Hayes Jr, Section of Pulmonary Medicine, the Ohio State University, Columbus, OH 43210, United States
Author contributions: Mumtaz K and Metwally S conceived and designed the study; Tumin D acquired the data and performed the statistical analysis; Tumin D, Mumtaz K and Metwally S interpreted the data, wrote and revised the manuscript; Hanje J, Michaels AJ, Modi RM, Patel N, Hayes Jr D, El-Hinnawi A and Black SM contributed to the conception and design of the study and revision of the manuscript.
Institutional review board statement: The study was approved by the Nationwide Children’s Hospital Institutional Review Board with a waiver of individual consent (IRB14-00716).
Informed consent statement: None.
Conflict-of-interest statement: None of the authors have any conflicts of interest.
Data sharing statement: No other additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Khalid Mumtaz, MD, MSc, Assistant Professor, Wexner Medical Center, Gastroenterology, Hepatology and Nutrition Division, the Ohio State University, 410 W. 10th Ave, Columbus, OH 43210, United States. khalid.mumtaz@osumc.edu
Telephone: +1-614-2824675 Fax: +1-614-2938518
Received: August 19, 2016
Peer-review started: August 23, 2016
First decision: September 28, 2016
Revised: October 24, 2016
Accepted: November 16, 2016
Article in press: November 17, 2016
Published online: January 18, 2017
Abstract
AIM

To determine the impact of transjugular intrahepatic porto-systemic shunt (TIPS) on post liver transplantation (LT) outcomes.

METHODS

Utilizing the United Network for Organ Sharing (UNOS) database, we compared patients who underwent LT from 2002 to 2013 who had underwent TIPS to those without TIPS for the management of ascites while on the LT waitlist. The impact of TIPS on 30-d mortality, length of stay (LOS), and need for re-LT were studied. For evaluation of mean differences between baseline characteristics for patients with and without TIPS, we used unpaired t-tests for continuous measures and χ2 tests for categorical measures. We estimated the impact of TIPS on each of the outcome measures. Multivariate analyses were conducted on the study population to explore the effect of TIPS on 30-d mortality post-LT, need for re-LT and LOS. All covariates were included in logistic regression analysis.

RESULTS

We included adult patients (age ≥ 18 years) who underwent LT from May 2002 to September 2013. Only those undergoing TIPS after listing and before liver transplant were included in the TIPS group. We excluded patients with variceal bleeding within two weeks of listing for LT and those listed for acute liver failure or hepatocellular carcinoma. Of 114770 LT in the UNOS database, 32783 (28.5%) met inclusion criteria. Of these 1366 (4.2%) had TIPS between the time of listing and LT. We found that TIPS increased the days on waitlist (408 ± 553 d) as compared to those without TIPS (183 ± 330 d), P < 0.001. Multivariate analysis showed that TIPS had no effect on 30-d post LT mortality (OR = 1.26; 95%CI: 0.91-1.76) and re-LT (OR = 0.61; 95%CI: 0.36-1.05). Pre-transplant hepatic encephalopathy added 3.46 d (95%CI: 2.37-4.55, P < 0.001), followed by 2.16 d (95%CI: 0.92-3.38, P = 0.001) by TIPS to LOS.

CONCLUSION

TIPS did increase time on waitlist for LT. More importantly, TIPS was not associated with 30-d mortality and re-LT, but it did lengthen hospital LOS after transplantation.

Keywords: Transjugular intrahepatic porto-systemic shunt, Shunt, Liver, Transplantation, Ascites, Model for end-stage liver disease, Mortality, Transjugular

Core tip: The study was completed to determine the impact of transjugular intrahepatic porto-systemic shunt (TIPS) on post liver transplantation (LT) outcomes. Utilizing the United Network for Organ Sharing database, we compared patients who underwent LT from 2002 to 2013 who had undergone TIPS to those without TIPS for the management of ascites while on the LT waitlist. The impact of TIPS on 30-d mortality, length of stay (LOS), and need for re-LT were studied. TIPS was not commonly used in patients with ascites on the waitlist but did increase time on waitlist for LT. More importantly, TIPS was not associated with 30-d mortality and re-LT, but it did increase hospital LOS after transplantation.