A CONTROLLED ANALYSIS OF THE TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT IN LIVER-TRANSPLANT RECIPIENTS

Background. The transjugular intrahepatic portosystemic shunt (TIPS) i s an important treatment for complications of portal hypertension. As some authors have suggested that TIPS may facilitate liver transplanta tion technically, the objective of this study was to determine the imp act of TIPS on the liver transplant operation and its outcome. Methods . The analysis was designed as a retrospective cohort study using a mu lticenter database. Fifty-five patients with TIPS were matched with 55 controls on the basis of 10 pretransplant laboratory, clinical, and d emographic features. TIPS patients and control patients were compared with regard to duration of surgery, intraoperative blood product usage , liver and renal function, volume of ascites, survival, and hospital stay. For confirmatory purposes, a parallel analysis using linear regr ession methods was performed. Results. By matched analysis, TIPS patie nts had less ascites at surgery (mean 0.9+/-0.20 vs. 2.2+/-0.37 L, P=0 .005) and a slightly shorter time from incision to cross-clamp (mean 2 .1+/-0.10 vs. 2.5+/-0.15 hr, P=0.03). However, there were not signific ant differences for total operative time (mean 6.0+/-0.17 vs. 6.3+/-0. 25 hr, P=1.00), blood product usage, or any other outcome variable. Re gression analysis confirmed these results. Conclusions. TIPS does not significantly impact the course of liver transplantation surgery. Ther efore, preoperative portal decompression solely to facilitate liver tr ansplantation is not an appropriate indication for TIPS.