Severe Hyperbilirubinemia after Creation of Transjugular Intrahepatic Portosystemic Shunts: Natural History and Predictors of Outcome

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Abstract
Hyperbilirubinemia after creation of transjugular intrahepatic portosystemic shunts (TIPS) has been attributed to hemolysis and portal diversion, but the causes and natural history of this condition remain unknown. To determine clinical outcomes and predictors of severe hyperbilirubinemia after TIPS creation. Retrospective analysis of all patients who underwent TIPS creation from June 1990 to September 1996. Academic medical center. 19 adults who developed severe hyperbilirubinemia (bilirubin level > 171.0 µmol/L) within 1 month after TIPS creation were compared with 213 adults who did not develop hyperbilirubinemia after TIPS creation. TIPS creation. Laboratory measures and clinical outcomes. According to laboratory indices, hemolysis was unlikely to have occurred. By 90 days, 95% of patients with hyperbilirubinemia had died or had undergone liver transplantation compared with 17% of controls (P < 0.001). Predictors of hyperbilirubinemia included nonalcoholic causes of liver disease (P = 0.01) and a pre-TIPS prothrombin time of 17 seconds or more (P = 0.016). Severe hyperbilirubinemia after TIPS creation heralds a high risk for death or need for liver transplantation. Reduced hepatic reserve predicts the development of hyperbilirubinemia.

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