Long-Term Clinical Outcome of Patients with Cirrhosis and Refractory Ascites Treated with TIPS Insertion.
J Gastroenterol Hepatol. 2014 Aug 28;
Authors: Tan HK, James PD, Sniderman KW, Wong F
BACKGROUND AND AIM: Transjugular intrahepatic portosystemic shunt (TIPS) is indicated for the treatment of refractory ascites in cirrhosis. The long-term outcome of TIPS for refractory ascites is unknown. The aim of this study is to describe the natural history of patients with refractory ascites post-TIPS, and compared between polytetrafluoroethylene (PTFE)-covered versus bare stents.
METHODS: A retrospective chart review of patients who had TIPS for refractory ascites was conducted. Prospectively collected data include demographics, angiographic data, blood work and urinary sodium excretion.
RESULTS: One-hundred-and-thirty-six patients received TIPS (bare=104, covered=32) over 22 years. Patients with PTFE stents had lower INR and MELD score. More patients with bare stents developed shunt dysfunction (74.0% vs. 24.1%, p<0.0001) and required more TIPS revisions (1.6±0.2/patient vs. 0.2±0.1, p<0.0001). Urinary sodium excretion increased significantly from first month, and progressed to 98±9mmol/day at 12(th) month post-TIPS (p<0.001 vs. baseline), concurrent with improved renal function. Most patients (77.6%) completely cleared the ascites without diuretics, but many achieved this beyond two years. Number of TIPS revision was predictive of complete response at 12 months (OR 0.7, 95% CI 0.5-0.9, p<0.05). Age (HR=1.05 [95% CI 1.02-1.08], p<0.01), complete response (HR=0.22 [95% CI 0.12-0.40], p<0.0001) and PTFE stents (HR=0.23 [95% CI 0.05-0.97], p<0.05) were predictive of survival.
CONCLUSIONS: TIPS is an effective treatment for cirrhotic refractory ascites. Ascites clearance is dependent on number of TIPS revision, while survival is predicted by younger age, complete response and covered stent use, although era-effect likely contributed to improved survival with covered stent use.
PMID: 25168607 [PubMed - as supplied by publisher]