ePTFE-TIPS vs repetitive LVP plus albumin for the treatment of refractory ascites in patients with cirrhosis.

Abstract

BACKGROUND & AIMS:

Reduction in portal pressure by self-expandable polytetrafluoroethylene (ePTFE)-covered transjugular intrahepatic portosystemic shunts (TIPS) is a treatment option for refractory ascites. Data on clinical outcomes after ePTFE-TIPS vs repetitive large-volume paracentesis (LVP) plus albumin (A) administration for the treatment of patients with refractory ascites are limited.

METHODS:

Retrospective comparison of ePTFE-TIPS vs LVP+A in terms of (i) control of ascites, (ii) occurrence of overt hepatic encephalopathy (HE) and (iii) transplant-free survival in cirrhotic patients with refractory ascites.

RESULTS:

Among n = 221 patients with cirrhosis and refractory ascites, n = 140 received ePTFE-TIPS and were compared to n = 71 patients undergoing repetitive LVP+A. After ePTFE-TIPS, ascites was controlled without any further need for paracentesis in n = 76 (54%; n = 7 without and n = 69 with diuretics). The need for frequent large-volume paracentesis was significantly higher in the LVP+A group than with ePTFE-TIPS (median 0.67 (IQR: 0.23-2.63) months vs 49.5 (IQR: 5.07-102.60) months until paracentesis, log-rank P < .001). De-novo incidence of HE was similar in ePTFE-TIPS and LVP+A patients (log-rank P = .361). Implantation of ePTFE-TIPS was associated with improved 1-year survival as compared to LVP+A (65.6% vs 48.4%, log-rank P = .033). Age (odds ratio (OR):1.05; 95% confidence interval (95% CI):1.03-1.07; P < .001), serum albumin (OR: 0.95; 95% CI: 0.92-0.99; P = .013) and hepatocellular carcinoma (OR: 1.66; 95% CI: 1.06-2.58; P = .026) emerged as independent predictors of survival.

CONCLUSIONS:

ePTFE-TIPS results in superior control of ascites without increasing the risk for overt HE as compared to LVP+A. Although ePTFE-TIPS improved 1-year survival in cirrhotic patients with refractory ascites, its use was not independently associated with transplant-free survival.

• Authors: Theresa Bucsics, Sophie Hoffman, Johanna Grünberger, Maria Schoder, Wolfgang Matzek, Alexander Stadlmann, Mattias Mandorfer, Philipp Schwabl, Arnulf Ferlitsch, Markus Peck-Radosavljevic, Michael Trauner, Josef Karner, Franz Karnel, Thomas Reiberger
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 38 Issue 6 Pg. 1036-1044 (06 2018) ISSN: 1478-3231 [Electronic] United States
• PMID: 29091351 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Albumins
• Coated Materials, Biocompatible
• Diuretics
• Polytetrafluoroethylene

Topics

• Aged
• Albumins (therapeutic use)
• Ascites (etiology, mortality, therapy)
• Austria (epidemiology)
• Coated Materials, Biocompatible
• Diuretics (therapeutic use)
• Female
• Hepatic Encephalopathy (epidemiology)
• Humans
• Liver Cirrhosis (complications)
• Male
• Middle Aged
• Paracentesis
• Polytetrafluoroethylene
• Portasystemic Shunt, Transjugular Intrahepatic
• Proportional Hazards Models
• Recurrence
• Retrospective Studies
• Risk Factors
• Stents
• Tertiary Care Centers
• Treatment Outcome