SEVERE HYPERBILIRUBINEMIA AFTER CREATION OF TRANSJUGULAR INTRAHEPATICPORTOSYSTEMIC SHUNTS - NATURAL-HISTORY AND PREDICTORS OF OUTCOME

Background: Hyperbilirubinemia after creation of transjugular intrahep atic portosystemic shunts (TIPS) has been attributed to hemolysis and portal diversion, but the causes and natural history of this condition remain unknown. Objective: To determine clinical outcomes and predict ors of severe hyperbilirubinemia after TIPS creation. Design: Retrospe ctive analysis of all patients who underwent TIPS creation from June 1 990 to September 1996. Setting: Academic medical center. Patients: 19 adults who developed severe hyperbilirubinemia (bilirubin level > 171. 0 mu mol/L) within 1 month after TIPS creation were compared with 213 adults who did not develop hyperbilirubinemia after TIPS creation. Int ervention: TIPS creation. Measurements: Laboratory measures and clinic al outcomes. Results: According to laboratory indices, hemolysis was u nlikely to have occurred. By 90 days, 95% of patients with hyperbiliru binemia had died or had undergone liver transplantation compared with 17% of controls (P < 0.001). Predictors of hyperbilirubinemia included nonalcoholic causes of liver disease (P = 0.01) and a pre-TIPS prothr ombin time of 17 seconds or more (P = 0.016). Conclusions: Severe hype rbilirubinemia after TIPS creation heralds a high risk for death or ne ed for liver transplantation. Reduced hepatic reserve predicts the dev elopment of hyperbilirubinemia.