Impact of Tips Preliver Transplantationfor the Outcome Posttransplantation

The effects of transjugular intrahepatic portocavalshunt (TIPS) on the survival of grafts and patients afterliver transplantation (LTx) have only been documentedin small series and with only a comparativedescription with non-TIPS recipients. We evaluated 61TIPS patients who had a subsequent LTx and comparedthese with 591 patients transplanted with cirrhosiswithout TIPS. Pretransplant characteristicsweresimilar between groups. Graft survival at 1, 3 and5 years post-LTx was 85.2%, 77% and 72.1% (TIPS) and75.3%, 69.8% and 66.1% (controls). Patient survival atthe same points was 91.7%, 85% and 81.7%, respectively(TIPS) and 85.4%, 80.3% and 76.2% (controls).Cox regression showed the absence of TIPS pre-LTx,transfusion of >5 units of blood during LTx, intensivecare unit (ICU) stay post-LTx >3 days and earlier periodof transplant to be significantly associated with aworse patient and graft survival at 1 year. Migration ofthe TIPS stent occurred in 28% of cases, increasing thetime on bypass during LTx, but was not related to graftor patient survival. TIPS may improve portal supply tothe graft and reduce collateral flow, improving function.This may account for the improved adjusted graftand patient survival by Cox regression at 12 months.Long-term survival was not affected.