MELD Score Less Than 15 Predicts Prolonged Survival After Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites After Liver Transplantation

Feyssa, Eyob; Ortíz, Jorge; Grewal, Kevin; Azhar, Ashaur; Parsikia, Afshin; Tufail, Kashif; Hashemi, Nikroo; Brady, Paul S.; Araya, Víctor

doi:10.1097/tp.0b013e31820e014e

Cited by 31 publications

(39 citation statements)

References 28 publications

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“…85 These guidelines have also been found to be useful for placement of TIPS amongst posttransplant patients and it is recommended that TIPS be carried out only if the MELD score is <15 in these patients. 86 …”

Section: Transjugular Intrahepatic Portosystemic Placementmentioning

confidence: 99%

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

127

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Section: Transjugular Intrahepatic Portosystemic Placementmentioning

confidence: 99%

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

127

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“…Only few studies evaluated the clinical response to TIPS after LT in relationship to the combination of MELD score and the indication to TIPS [200,201,204,209]. Most Authors agree that transplant free survival is poorer and MELD threshold predicting poor survival is lower than those of patients with native livers [201,209,210]. The availability of the new DAAs is expected to modify the outcome of post-LT TIPS in HCV positive recipients.…”

Section: Haemophiliamentioning

confidence: 99%

“…Votes in Favour: 95%. Comment: TIPS has been shown to be effective in managing complications of portal hypertension also in patients listed for LT [25,196,197,201]. However, TIPS placement in patients on the waiting list for LT may influence several clinical aspects not only related to the outcome of primary complication of liver disease (i.e.…”

Section: Session 5: Tips In Liver Transplant Settingmentioning

confidence: 99%

“…However, TIPS placement in patients on the waiting list for LT may influence several clinical aspects not only related to the outcome of primary complication of liver disease (i.e. gastrointestinal bleeding or refractory ascites), but also related to the patient's priority in the waiting list due to MELD score modifications [10,11,196,197,199,[201][202][203]. [115,196,199,202,203,207].…”

Section: Session 5: Tips In Liver Transplant Settingmentioning

confidence: 99%

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Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

127

120

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a b s t r a c tThe trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty. On this basis, the Italian Association of the Study of the Liver (AISF), the Italian College of Interventional Radiology-Italian Society of Medical Radiology (ICIR-SIRM), and the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) promoted a Consensus Conference on TIPS. Under the auspices of the three scientific societies, the consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Bergamo on June 4th and 5th, 2015. The final statements presented here were graded according to quality of evidence and strength of recommendations and were approved by an independent jury. By highlighting strengths and weaknesses of current indications to TIPS, the recommendations of AISF-ICIR-SIRM-SIAARTI may represent the starting point for further studies.

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“…1 We published the outcomes for 26 patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement for intractable ascites after liver transplantation. 2 We also found that a Model for End-Stage Liver Disease score less than 15 predicted prolonged survival after TIPS placement in liver transplant recipients. Our experience remains the largest documented experience in the English literature.…”

mentioning

confidence: 74%

Transjugular intrahepatic portosystemic shunts

et al. 2011

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TO THE EDITORS:We read with great interest King et al.'s article entitled ''A Case-Controlled Study of the Safety and Efficacy of Transjugular Intrahepatic Portosystemic Shunts After Liver Transplantation.'' 1 We published the outcomes for 26 patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement for intractable ascites after liver transplantation. 2 We also found that a Model for End-Stage Liver Disease score less than 15 predicted prolonged survival after TIPS placement in liver transplant recipients. Our experience remains the largest documented experience in the English literature. Eighty-eight percent of our patients were infected with hepatitis C virus. Only 37% were biopsy-proven to have cirrhosis. The technical success rate was 100%. The primary patency rate was 81%. Fifty-seven percent of the procedures were considered clinically successful. Fifty percent of the patients were alive at 1 year. We are gratified that King et al.'s case-controlled trial has validated our results. We believe that TIPS placement is an important intervention for patients with refractory ascites after liver transplantation.So that we could analyze a uniform cohort, we excluded 4 TIPS procedures performed for variceal bleeding after transplantation. At this point, we believe that TIPS placement for variceal bleeding is understudied. There are not enough patients in this publication (or in our experience) to make cogent and defensible conclusions. We look forward to the prospective collection of data for these procedures, and we hope that this will provide support for this intervention in these complex patients.

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MELD Score Less Than 15 Predicts Prolonged Survival After Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites After Liver Transplantation

Abstract: TIPS after LT can be clinically effective in patients with RA with a MELD score less than 15. This suggests that TIPS could be used as a means to extend posttransplant survival but should be carefully individualized in patients with a MELD score more than or equal to 15.

Cited by 31 publications

References 28 publications

Model for End-stage Liver Disease

Model for End-stage Liver Disease

Consensus conference on TIPS management: Techniques, indications, contraindications

Transjugular intrahepatic portosystemic shunts

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