EFFECT OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT ON QUALITY-OF-LIFE

OBJECTIVE. The objective of this study was to determine the effect of the transjugular intrahepatic portosystemic shunt (TIPS) procedure on the quality of life. SUBJECTS AND METHODS. Data were collected on 99 p atients who underwent the TIPS procedure between September 1991 and Se ptember 1995. Quality of life was assessed by the Karnofsky scale befo re and at intervals after the procedure. Procedure-related complicatio ns and other aspects of the patients' overall well-being, as reflected in liver and kidney function and nutritional status, were reviewed im mediately before and after TIPS creation. Finally, mortality and TIPS patency rates were tabulated. RESULTS. We observed significantly impro ved quality of life. The quality of life remained significantly improv ed throughout the 24-month follow-up period. During the 1- to 3-month interval after the TIPS procedure, we observed in patients a significa nt decrease in blood urea nitrogen and an increase in albumin and bili rubin. During this period, patients had no significant change in liver enzymes, prothrombin time, ammonia, or creatinine. Complications of t he TIPS procedure included a 30% incidence of new or worsened encephal opathy and a 15% incidence of other severe complications (intraperiton eal hemorrhage, severe accelerated liver failure). The procedure-relat ed death rate was 5%. Longer term follow-up showed an overall sustaine d decrease in blood urea nitrogen, an increase in albumin, and a retur n of bilirubin to the pre-TIPS levels or below. CONCLUSION. For patien ts who survive longer than 1 month, TIPS results in an overall, sustai ned improvement in the quality of life. Improved quality of life may r esult from a low incidence of repeat variceal bleeding, decreased asci tes, and improved nutritional status.