Dhaliwal A, Merhzad H, Karkhanis S, Tripathi D. Covered transjugular intrahepatic portosystemic stent-shunt vs large volume paracentesis in patients with cirrhosis: A real-world propensity score-matched study. World J Clin Cases 2022; 10(31): 11313-11324 [PMID: 36387790 DOI: 10.12998/wjcc.v10.i31.11313]
Corresponding Author of This Article
Dhiraj Tripathi, MD, Professor, Department of Hepatology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TT, United Kingdom. dhiraj.tripathi@uhb.nhs.uk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 6, 2022; 10(31): 11313-11324 Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11313
Covered transjugular intrahepatic portosystemic stent-shunt vs large volume paracentesis in patients with cirrhosis: A real-world propensity score-matched study
Amritpal Dhaliwal, Dhiraj Tripathi, Department of Hepatology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom
Amritpal Dhaliwal, Dhiraj Tripathi, National Institute of Health and Care Research, Biomedical Research Centre Birmingham, University of Birmingham, Birmingham B15 2WB, United Kingdom
Homoyoon Merhzad, Salil Karkhanis, Department of Radiology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom
Author contributions: Tripathi D conceptualized the study design; Dhaliwal A collected the study data; Tripathi D performed the analysis; Dhaliwal A drafted the manuscript; Dhaliwal A, Tripathi D, Karkhanis S and Merhzad H edited and revised the manuscript.
Institutional review board statement: This study was performed following authorisation by the Clinical Audit and Registries Management Service, University Hospitals of Birmingham Research Governance and Audit team.
Conflict-of-interest statement: Dhiraj Tripathi has received speaker fees from GORE medical.
Data sharing statement: All data was anonymised and no patient identifiable information has been used. Consent for data use obtained by authorisation by the Clinical Audit and Registries Management Service, University Hospitals of Birmingham Research Governance and Audit team.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dhiraj Tripathi, MD, Professor, Department of Hepatology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TT, United Kingdom. dhiraj.tripathi@uhb.nhs.uk
Received: May 14, 2022 Peer-review started: May 14, 2022 First decision: June 19, 2022 Revised: July 5, 2022 Accepted: September 20, 2022 Article in press: September 20, 2022 Published online: November 6, 2022
Abstract
BACKGROUND
Refractory ascites has a 1-year survival rate of 50%. In selected patients, treatment options include liver transplantation (LT) or transjugular intrahepatic portosystemic stent shunt (TIPSS).
AIM
To assess the outcomes of patients who underwent a TIPSS compared to large volume paracentesis (LVP).
METHODS
Retrospective study of patients who underwent a covered TIPSS or LVP for refractory or recurrent ascites over 7 years. Primary outcome was transplant-free survival (TFS). Further analysis was done with propensity score matching (PSM).
RESULTS
There were 150 patients [TIPSS group (n = 75), LVP group (n = 75)]. Seven patients in the TIPSS group underwent LT vs 22 patients in the LVP group. Overall median follow up, 20 (0.47-179.53) mo. In the whole cohort, there was no difference in TFS [hazard ratio (HR): 0.80, 95% confidence interval (CI): 0.54-1.21]; but lower de novo hepatic encephalopathy with LVP (HR: 95%CI: 0.20-0.96). These findings were confirmed following PSM analysis. On multivariate analysis albumin and hepatocellular carcinoma at baseline were associated with TFS.
CONCLUSION
Covered TIPSS results in similar TFS compared to LVP in cirrhotic patients with advanced liver failure. Liver transplant assessment should be considered in all potential candidates for TIPSS. Further controlled studies are recommended to select appropriate patients for TIPSS.
Core Tip: Refractory ascites is a serious complication of cirrhosis and portal hypertension with a one-year mortality of 50%. The only curative treatment for refractory ascites is liver transplantation, whilst the non-surgical treatments for refractory ascites include large volume paracentesis (LVP) and transjugular intrahepatic portosystemic stent shunt (TIPSS). A randomized controlled trial showed covered TIPSS can improve survival compared to LVP. In our real world cohort of selected patients with cirrhosis and advanced liver failure, we demonstrate that covered TIPSS results in similar transplant free survival compared to LVP following propensity score matching. This suggests that all patients with refractory ascites that are eligible for TIPSS should be considered for liver transplantation.
