Early Transjugular Intrahepatic Portosystemic Shunt For Acute Variceal Bleeding In Liver Cirrhosis:a Single-arm Retrospective Study

Backgroud and Aim: Acute variceal bleeding is a common and life-threatening complication of liver cirrhosis. The standard treatment recommended by guidelines and statements of expert consensus includes the early use of vasoactive drugs, prophylactic antibiotics and endoscopic therapy. However, transjugular intrahepatic portosystemic shunt(TIPS) is recommended by the guidelines as a salvage treatment. There have been encouraging reports on early TIPS for acute variceal bleeding. Long-term data are lacking. The aim of this study is to examine the long-term effectiveness, complications, survival, and prognostic factors of early TIPS in patients with cirrhosis and acute variceal bleeding. Methods:Consecutive patients who underwent TIPS within 5 days after an episode of variceal bleeding between January 2002 and December 2011 were reviewed retrospectively. All patients with acute variceal bleeding were included unless they had any of the following conditions: hepatocellular carcinoma(HCC); previous use of a portosystemic shunt or TIPS; total portal-vein thrombosis. Clinical, laboratory, imaging and procedure-related data were collected to evaluate the rebleeding rate, survival, hepatic encephalopathy(HE) and other complications of early TIPS in patients with cirrhosis and acute variceal bleeding. The data were obtained by electronic medical records, clinical visits or telephone calls with patients or their relatives.The patients were followed up from their date of TIPS placement until death or to the end of the study(July 1st, 2013).Results: Sixty-six patients were included in the study. TIPS was successfully performed in 65 of 66 patients, and hemostasis was achieved in all of these patients. During the follow-up period(median, 26.7 months), shunt dysfunction occurred in 11(16.9%) patients. The rates of a first episode of HE at 6 weeks, 1 year, 2 years, 5 years and 9 years were 26.8%, 36.0%, 43.5%, 54.6% and 54.6%, respectively. The rebleeding rates at 6 weeks, 1 year, 2 years, 5 years and 9 years were 9.5%, 16.3%, 30.6%, 56.7% and 65.3%, respectively. The survival rates at 6 weeks, 1 year, 2 years, 5 years and 9 years were 92.2%, 78.1%, 67.9%, 44.8% and 44.8%, respectively. In the high-risk group patients, the 6-week,1-year and 2-year rebleeding rates were 0%, 14.2% and 24.6%, and the 6-week, 1-year and 2-year survival rates were 88.5%, 65.4% and 49.5%. The multivariate analysis showed that older age and high Child-Pugh scores were independent risk factors related to overall survival.Conclusion: Early TIPS is highly effective for controlling acute variceal bleeding. The 6-week rebleeding rate and mortality are low in acute variceal bleeding patients who received early TIPS. Older age and high Child-Pugh scores are independent risk factors related to overall survival.