Effect of liver volume in morbidity and mortality after elective transjugular intrahepatic portosystemic shunt
Background: To study the effect of liver volume (LV) in the morbidity and mortality after elective transjugular intrahepatic portosystemic shunt (TIPS). Methods: A retrospective review was performed in patients admitted for elective TIPS between 2003 and 2009. Eighty patients were included in the study. LV was measured by computed tomography or magnetic resonance imaging performed 1-3 months prior to the procedure. A possible correlation between LV and major adverse events [hepatic
... epatic encephalopathy (HE) requiring hospital admission, increase in >2 points in MELD (Model for End-Stage Liver Disease) score >18 points, need for emergent orthotopic liver transplantation (OLT) and/or death] within 6 months after TIPS was studied. Results: MELD score ranged from 7 to 23 (median: 14) prior to, and from 7 to 43 (median: 17) after TIPS. Post-MELD score and severe HE varied significantly with death status in crude analysis. Pre-MELD score and HE were revealed to be significant predictors of death from an adjusted logistic model. No significant associations were found when modeling LV in terms of death or HE. LV was significantly smaller in patients that underwent OLT (n ¼ 18) than those who did not undergo OLT after TIPS (n ¼ 62; P ¼ 0.04). Furthermore, the LV of patients who required emergency OLT for liver failure after TIPS (n ¼ 10), was significantly decreased compared to patients that underwent elective TIPS without OLT (P ¼ 0.03). Conclusion: Overall, LV was not correlated with major adverse events within 6 months after elective TIPS. However, those patients requiring OLT after TIPS had significantly smaller LV than those not requiring OLT after TIPS.