To investigate the relevant factors of significant increase of total bilirubin in short term after transjugular intrahepatic portosystemic shut (TIPS) and the influence of survival prognosis.

A retrospective review including 202 patients with cirrhotic portal hypertension undergoing TIPS from January 2009 to December 2015 was performed. All patients were divided into two groups: without significant increase of total bilirubin in short term (group A, n=106) and significant increase of total bilirubin in short term (group B, n=96) after TIPS. The relative factors affecting significant increase of total bilirubin in short term after TIPS were analyzed by single factor analysis and multivariate non conditional Logistics regression model, and the survival prognosis of the two groups were analyzed by long-term follow-up.

The intrahepatic shunts were established successfully in all patients. The preoperative portal venous pressure was (24.2±5.1) mmHg, while postoperative portal venous pressure was (14.6±4.3) mmHg, with statistical difference (t=17.33, P<0.01) . The preoperative total bilirubin was (23.27±18.67) μmol/L, while total bilirubin was (36.52±28.17) μmol/L two weeks after TIPS, with statistical difference (t=6.461, P<0.01) . Single variate analysis showed that age, preoperative total bilirubin, preoperative Child-Pugh score and length of intrahepatic stent in group B were all higher than those of group A (P<0.05) , and there were statistical differences in pathogenesis of portal hypertension, puncture sites of portal vein, postoperative development of portal branch and type of stent between two groups (P<0.05) . Multivariate logistic regression model showed that the sign of significant increase of total bilirubin in short term after TIPS related to preoperative total bilirubin, preoperative Child-Pugh score, length of intrahepatic stent and postoperative development of portal branch. Kaplan-Meier analysis showed that group A had higher survival rate than group B (χ²=4.528, P=0.033) , and there was no significant difference between two groups in shunt patency and HE.

Preoperative higher total bilirubin, preoperative higher Child-Pugh score and longer intrahepatic stent are the independent risk factors for significant increase of total bilirubin in short term after TIPS, while postoperative more development of portal branch is the independent protective factor. Significant increase of total bilirubin in short term after TIPS might have lower survival rate.