The Role of Transjugular Intrahepatic Portosystemic Shunt in Acute Variceal Bleding: Diferential Survival Owing to Diferent Cirhosis Etiology

Background and Aim: Transjugular intrahepatic portosystemic shunt (TIPS) procedures are increasingly used to treat severe complications of portal hypertension, while its efficacy in treating acute variceal bleeding caused by different etiology of liver cirrhosis has not yet being evaluated. This study aims to evaluate whether different etiology of liver cirrhosis may influence the outcome of TIPS treatment for acute variceal bleeding. Materials and Methods: A total of 74 patients with acute variceal bleeding receiving TIPS treatment from March 2004 to December 2006 were enrolled for the analysis. They were divided into four groups: HBV-related (Group Ⅰ, n=22), HCV-related (Group Ⅱ, n=25) and Alcohol-related (Group Ⅲ, n=19) as well as Others (Group Ⅳ, n=8). The hepatic venous pressure gradient (HVPG) was measured before (pre-TIPS) and after (post-TIPS) the procedure and immediate stop bleeding was assessed. Survival curves were constructed by the Kaplan-Meier method, and compared by log-rank test. Results: Survival for the whole patient group after TIPS was short with a mean of 9.6±14.5 months and with a median survival time of 3.0 months. Patient group Ⅳ(Others) had the best outcome with a median survival time of 24 months after TIPS (overall P＜0.05), while alcohol liver cirrhosis patients (Group Ⅲ) had the worst outcome after TIPS with a median survival time of 2.0 months. HCC patients receiving the TIPS therapy for acute variceal bleeding survived shorter than those without HCC (P=0.008, log-rank test). Conclusions: Different etiology of liver cirrhosis may influence the outcome of TIPS treatment for acute variceal bleeding. Despite its apparent efficacy for emergent conditions, TIPS procedure should be limited to salvage therapy as a transition to liver transplantation.