A controlled analysis of the transjugular intrahepatic portosystemic shunt in liver transplant recipients. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Liver Transplantation Database.
A controlled analysis of the transjugular intrahepatic portosystemic shunt in liver transplant recipients. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Liver Transplantation Database.
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DOI：
10.1097/00007890-199704270-00005
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发表时间：
1997-04
期刊：
影响因子：
6.2
通讯作者：
K. Somberg;Manuel Lombardero;Sharon Lawlor;N. Ascher;J. Lake;Russell H. Wiesner;R. Zetterman
中科院分区：
文献类型：
--
作者：
K. Somberg;Manuel Lombardero;Sharon Lawlor;N. Ascher;J. Lake;Russell H. Wiesner;R. Zetterman
背景经颈静脉肝内门体分流术（TIPS）是治疗门静脉高压症并发症的重要手段。由于一些作者认为TIPS可能在技术上促进肝移植，本研究的目的是确定TIPS对肝移植手术及其结局的影响。方法采用多中心数据库设计的回顾性队列研究。根据10项移植前实验室、临床和人口统计学特征，将55例TIPS患者与55例对照组相匹配。比较TIPS患者和对照组患者的手术时间、术中血液制品使用、肝肾功能、腹水量、生存率和住院时间。为了验证目的，使用线性回归方法进行了平行分析。结果通过匹配分析，TIPS患者手术时腹水较少（平均0.9+/-0.20vs. 2. 2 +/-0.37L，P=0.005），从切开到阻断的时间略短（平均2.1+/-0.10vs. 2. 5 +/-0.15hr，P=0.03）。然而，总手术时间（平均6.0+/-0.17小时vs. 6.3+/-0.25小时，P=1.00）、血液制品使用或任何其他结局变量无显著差异。回归分析证实了这些结果。结论TIPS对肝移植手术过程无明显影响。因此，术前单纯为肝移植而行门静脉减压并不是TIPS的合适指征。
BACKGROUND The transjugular intrahepatic portosystemic shunt (TIPS) is an important treatment for complications of portal hypertension. As some authors have suggested that TIPS may facilitate liver transplantation technically, the objective of this study was to determine the impact of TIPS on the liver transplant operation and its outcome. METHODS The analysis was designed as a retrospective cohort study using a multicenter database. Fifty-five patients with TIPS were matched with 55 controls on the basis of 10 pretransplant laboratory, clinical, and demographic features. TIPS patients and control patients were compared with regard to duration of surgery, intraoperative blood product usage, liver and renal function, volume of ascites, survival, and hospital stay. For confirmatory purposes, a parallel analysis using linear regression methods was performed. RESULTS By matched analysis, TIPS patients had less ascites at surgery (mean 0.9+/-0.20 vs. 2.2+/-0.37 L, P=0.005) and a slightly shorter time from incision to cross-clamp (mean 2.1+/-0.10 vs. 2.5+/-0.15 hr, P=0.03). However, there were not significant differences for total operative time (mean 6.0+/-0.17 vs. 6.3+/-0.25 hr, P=1.00), blood product usage, or any other outcome variable. Regression analysis confirmed these results. CONCLUSIONS TIPS does not significantly impact the course of liver transplantation surgery. Therefore, preoperative portal decompression solely to facilitate liver transplantation is not an appropriate indication for TIPS.