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
ARTICLE HIGHLIGHTS
Research 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).
Research motivation
We aimed to assess the outcomes of patients who underwent a TIPSS compared to large volume paracentesis (LVP).
Research objectives
We devised a retrospective study of patients who underwent a covered TIPSS or LVP for refractory or recurrent ascites over 7 years.
Research methods
Primary outcome was transplant-free survival (TFS). Further analysis was done with propensity score matching (PSM).
Research 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: 0.44, 95%CI: 0.20-0.96). These findings were confirmed following PSM analysis. On multivariate analysis albumin and HCC at baseline were associated with TFS.
Research conclusions
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.
Research perspectives
Future research should be targeted at controlled studies are recommended to select appropriate patients for TIPSS.
