Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis

Background/Aims: The place of transjugular intrahepatic porto-systemic shun t (TIPS) for variceal haemorrhage uncontrolled by sclerotherapy and medical treatment is still undefined. To investigate the outcome of early salvage TIPS for active uncontrolled variceal haemorrhage, and to identity the fact ors associated with mortality. Methods: Salvage TIPS was performed in 58 patients as soon as possible afte r the diagnosis of variceal bleeding refractory to the combination of scler otherapy and of pharmacological therapy. Twenty-three variables were assess ed prospectively to identify predictors of mortality within 60 days of the procedure. Results: The haemorrhage was controlled in 52 of 58 patients (90%). Bleedin g persisted in six of 58 patients (10%), and recurred in four patients (7%) . Overall, 17 (29%) and 20 (35%) patients died within respectively 30 days and 60 days of TIPS: five patients died of persistent bleeding, two patient s died of recurrent bleeding, and 13 patients died of terminal liver failur e. The actuarial survival following salvage TIPS was 51.7% at 1 year. On mu ltivariate analysis, independent predictors of early mortality were: the pr esence of sepsis (P = 0.001), the use of catecholamines for systemic hemody namic impairment (P = 0.009), and the use of balloon tamponade (P = 0.04). Neither a single factor, nor a combination of factors before TIPS allowed t o predict mortality confidently in a given patient. Conclusions: Early salvage TIPS is an effective treatment to stop active va riceal bleeding refractory to sclerotherapy and pharmacological treatment. Pre-treatment prognostic determinants that correlate to mortality can not b e used to predict the outcome in individual cases. (C) 2001 European Associ ation for the Study of the Liver. Published by Elsevier Science B.V. All ri ghts reserved.