Theresa Bucsics1,2, Sophie Hoffman1,2, Johanna Grünberger1,2, Maria Schoder3, Wolfgang Matzek3, Alexander Stadlmann1,2, Mattias Mandorfer1,2, Philipp Schwabl1,2, Arnulf Ferlitsch1,2, Markus Peck-Radosavljevic1,2,4, Michael Trauner1,2, Josef Karner5, Franz Karnel6, Thomas Reiberger1,2. 1. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. 2. Vienna Hepatic Hemodynamic Laboratory, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. 3. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria. 4. Department of Gastroenterology and Hepatology, Endocrinology, and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria. 5. Department of Surgery, Kaiser-Franz Josef Spital, Vienna, Austria. 6. Department of Radiology, Kaiser-Franz Josef Spital, Vienna, Austria.
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.
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; Katharina Lampichler; Constantin Vierziger; Maria Schoder; Florian Wolf; David Bauer; Benedikt Simbrunner; Lukas Hartl; Mathias Jachs; Bernhard Scheiner; Michael Trauner; Thomas Gruenberger; Franz Karnel; Mattias Mandorfer; Thomas Reiberger Journal: Dig Dis Sci Date: 2022-03-17 Impact factor: 3.199
Authors: Elisabeth Schwaiger; Amrei Simon; Peter Wabel; Benjamin Schairer; Carolin Berner; Lorenzo Signorini; Matthäus Ernstbrunner; Rayko Evstatiev; Philipp Schwabl; Georg Hinterholzer; Florian Frommlet; Andreas Vychytil; Christian J Müller; Manfred Hecking Journal: Sci Rep Date: 2020-02-18 Impact factor: 4.379
Authors: Lena Stockhoff; Theresa Muellner-Bucsics; Antoaneta A Markova; Marie Schultalbers; Simone A Keimburg; Tammo L Tergast; Jan B Hinrichs; Nicolas Simon; Svetlana Gerbel; Michael P Manns; Mattias Mandorfer; Markus Cornberg; Bernhard C Meyer; Heiner Wedemeyer; Thomas Reiberger; Benjamin Maasoumy Journal: Hepatol Commun Date: 2021-09-28