Mumtaz K, Metwally S, Modi RM, Patel N, Tumin D, Michaels AJ, Hanje J, El-Hinnawi A, Hayes Jr D, Black SM. Impact of transjugular intrahepatic porto-systemic shunt on post liver transplantation outcomes: Study based on the United Network for Organ Sharing database. World J Hepatol 2017; 9(2): 99-105 [PMID: 28144391 DOI: 10.4254/wjh.v9.i2.99]
Corresponding Author of This Article
Khalid Mumtaz, MD, MSc, Assistant Professor, Wexner Medical Center, Gastroenterology, Hepatology and Nutrition Division, the Ohio State University, 410 W. 10th Ave, Columbus, OH 43210, United States. khalid.mumtaz@osumc.edu
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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World J Hepatol. Jan 18, 2017; 9(2): 99-105 Published online Jan 18, 2017. doi: 10.4254/wjh.v9.i2.99
Table 1 Demographics and clinical variables categorized by transjugular intrahepatic porto-systemic shunt status
Variables
TIPS on waitlist (n = 1366; % or mean ± SD)
Non TIPS on waitlist (n = 31417; % or mean ± SD)
P-values
Male candidate
943 (69)
21374 (68)
0.43
Candidate race
< 0.001
White
1072 (78.4)
23063 (73.4)
Black
75 (5.4)
2865 (9.1)
Other
219 (16)
5489 (17.4)
Diabetes mellitus
380 (28)
7769 (24.8)
0.009
ALD
311 (22.7)
6615 (21)
0.13
Hepatic encephalopathy
0.01
None
373 (27.3)
8409 (26.7)
Grade 1-2
925 (67.7)
20790 (66.1)
Grade 3-4
68 (4.9)
2218 (7)
Arterial hypertension
68 (14.8)
2254 (19.7)
0.01
Age
53.5 ± 8.5
53.6 ± 9.3
0.65
MELD score at listing
16.6 ± 6.6
19.66 ± 8.8
< 0.001
Creatinine
1.2 ± 0.8
1.4 ± 1.2
< 0.001
Bilirubin
4.1 ± 6.3
6.61 ± 9.0
< 0.001
INR
1.5 ± 0.4
1.7 ± 0.8
< 0.001
Albumin
2.9 ± 0.6
2.9 ± 0.6
0.66
BMI at list entry
Continuous (kg/m2)
28.8 ± 5.6
28.8 ± 5.7
0.89
Dichotomous (≥ 26 kg/m2)
905 (66.4)
20747 (66.2)
0.85
Cold ischemia time
Continuous (h)
7.1 ± 3.7
6.9 ± 3.5
0.03
Dichotomous (> 12 h)
66 (5.0)
1360 (4.5)
0.38
MELD score at transplantation
23.1 ± 9.1
22.6 ± 9.7
0.03
Table 2 Comparison of various outcomes on univariate analysis on waitlist and post liver transplant
TIPS on waitlist (n = 1366) % or mean ± SD
No TIPS on waitlist (n = 31417) % or mean ± SD
P-values
Days on LT waitlist
408 ± 552.6
183 ± 330.5
< 0.001
Mortality within 30 d
46 (3.5)
915 (3.0)
0.344
Length of hospital stay
17.58 ± 22.4
16.62 ± 22.1
0.118
Re-LT at 30 d
15 (1.1)
560 (1.8)
0.06
Table 3 Multivariable logistic regression analysis to assess the impact of transjugular intrahepatic porto-systemic shunt on 30-d mortality after liver transplant
Variable
OR (95%CI)
P-values
TIPS
1.26 (0.90-1.75)
0.17
Male candidate
0.83 (0.71-0.95)
0.01
Candidate race
White
Ref.
Black
1.08 (0.85-1.37)
0.54
Other
1.08 (0.90-1.29)
0.40
Diabetes mellitus
1.12 (0.95-1.31)
0.17
ALD
0.89 (0.74-1.07)
0.22
Hepatic encephalopathy
None
Ref.
Grade 1-2
0.86 (0.73-1.01)
0.06
Grade 3-4
1.12 (0.85-1.47)
0.41
Age
1.02 (1.01-1.03)
< 0.001
MELD score
1.02 (1.00-1.04)
0.05
Creatinine
1.03 (0.97-1.10)
0.33
Bilirubin
1.01 (1.00-1.02)
0.008
INR
0.97 (0.86-1.09)
0.59
Albumin
0.88 (0.79-0.98)
0.03
BMI
1.00 (0.99-1.02)
0.86
Cold ischemia time
1.04 (1.02-1.05)
< 0.001
Table 4 Multivariable logistic regression analysis to assess the impact of transjugular intrahepatic porto-systemic shunt on retransplantation
Variable
OR (95%CI)
P-values
TIPS
0.61 (0.36-1.05)
0.07
Male candidate
1.02 (0.85-1.24)
0.81
Candidate race
White
Ref.
Black
1.22 (0.91-1.64)
0.18
Other
1.05 (0.83-1.32)
0.69
Diabetes mellitus
0.98 (0.78-1.21)
0.83
ALD
0.98 (0.78-1.24)
0.90
Hepatic encephalopathy
None
Ref.
Grade 1-2
0.92 (0.76-1.13)
0.44
Grade 3-4
1.02 (0.69-1.51)
0.91
Age
0.97 (0.96-0.98)
< 0.001
MELD score
0.99 (0.97-1.02)
0.51
Creatinine
0.87 (0.77-0.99)
0.03
Bilirubin
0.99 (0.98-1.02)
0.54
INR
1.01 (0.86-1.18)
0.9
Albumin
1.03 (0.89-1.19)
0.65
BMI
1.005 (0.98-1.02)
0.54
Cold ischemia time
1.05 (1.03-1.07)
< 0.001
Table 5 Ordinary least squares regression to assess the impact of transjugular intrahepatic porto-systemic shunt on length of hospital stay after liver transplant
Variable
β (95%CI)
P-values
TIPS
2.16 (0.92-3.38)
0.001
Male candidate
-1.99 (-2.52-1.46)
< 0.001
Candidate race
White
Ref.
Black
-1.58 (-2.46-0.69)
< 0.001
Other
0.11 (-0.53-0.77)
0.72
Diabetes mellitus
0.52 (-0.05-1.10)
0.07
ALD
0.17 (-0.44-0.79)
0.57
Hepatic encephalopathy
None
Ref.
Grade 1-2
-0.10 (-0.66-0.46)
0.73
Grade 3-4
3.46 (2.37-4.55)
< 0.001
Age
0.09 (0.06-0.11)
< 0.001
MELD score
0.37 (0.31-0.44)
< 0.001
Creatinine
0.05 (-0.21-0.31)
0.71
Bilirubin
0.03 (-0.008-0.08)
0.1
INR
-1.06 (-1.50-0.61)
< 0.001
Albumin
-0.63 (-1.01-0.24)
0.001
BMI
-0.05 (-0.100-0.01)
0.01
Cold ischemia time
0.36 (0.29-0.43)
< 0.001
Constant
7.83 (5.38-10.27)
< 0.001
Citation: Mumtaz K, Metwally S, Modi RM, Patel N, Tumin D, Michaels AJ, Hanje J, El-Hinnawi A, Hayes Jr D, Black SM. Impact of transjugular intrahepatic porto-systemic shunt on post liver transplantation outcomes: Study based on the United Network for Organ Sharing database. World J Hepatol 2017; 9(2): 99-105