Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2022; 28(41): 5944-5956
Published online Nov 7, 2022. doi: 10.3748/wjg.v28.i41.5944
Transjugular intrahepatic portosystemic shunt vs conservative treatment for recurrent ascites: A propensity score matched comparison
Martin Philipp, Theresia Blattmann, Jörn Bienert, Kristian Fischer, Luisa Hausberg, Jens-Christian Kröger, Thomas Heller, Marc-André Weber, Georg Lamprecht
Martin Philipp, Theresia Blattmann, Jörn Bienert, Kristian Fischer, Luisa Hausberg, Georg Lamprecht, Department of Medicine, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock 18057, Germany
Jens-Christian Kröger, Thomas Heller, Marc-André Weber, Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Centre, Rostock 18057, Germany
Author contributions: Philipp M, Blattmann T, Bienert J, Fischer K, and Hausberg L designed the research study and acquired the data; Philipp M and Lamprecht G analyzed the data and wrote the manuscript; Kröger JC, Heller T, and Weber MA performed transjugular intrahepatic portosystemic shunt placement and critically revised the manuscript; all authors have read and have approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Rostock University Medical Center (Approval No. A2018-0127).
Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board considering the retrospective design of the study. Nevertheless, informed consent was obtained from all available patients.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: De-identified data and statistical code used in this study are available from the corresponding author upon reasonable request.
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: Georg Lamprecht, MD, Academic Research, Director, Doctor, Full Professor, Department of Medicine, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, 6 Ernst-Heydemann-Street, Rostock 18057, Germany. georg.lamprecht@med.uni-rostock.de
Received: July 9, 2022
Peer-review started: July 9, 2022
First decision: September 2, 2022
Revised: September 15, 2022
Accepted: October 19, 2022
Article in press: October 19, 2022
Published online: November 7, 2022
ARTICLE HIGHLIGHTS
Research background

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for recurrent tense ascites. Acute on chronic liver failure (ACLF) of various severities is a serious complication usually causally attributed to TIPS placement. But the potential of TIPS to improve ACLF grade 1 and 2, which is mostly related to acute kidney injury in these patients, may be underestimated.

Research motivation

TIPS placement for recurrent tense ascites may be beneficial even in patients with severely impaired liver and kidney function. But the exact medical limits need further clarification.

Research objectives

To retrospectively evaluate the in-hospital mortality of patients with recurrent tense ascites and reduced liver function-including severely reduced liver function-undergoing TIPS placement (TIPS group) and to compare these data to a carefully matched cohort with recurrent tense ascites receiving conservative treatment (No TIPS group). To better address the clinical scenario not only the time after TIPS placement but the entire hospital stays was analyzed.

Research methods

Two hundred and twenty-four patients undergoing TIPS placement for recurrent tense ascites were retrospectively compared to an equal number of propensity score matched, conservatively treated patients. Primary objectives were in-hospital mortality and the development or worsening or improvement of ACLF. Additional multivariate logistic regressions were performed as sensitivity analysis and for further insights into effects of liver function, TIPS placement and their interaction on ACLF incidence and in-hospital mortality.

Research results

TIPS placement did not result in an increased in-hospital mortality compared to the matched cohort. ACLF incidence in the TIPS group depended on liver function: At Child-Pugh-Scores < 8 TIPS reduced the risk of ALCF development, at scores of 8 to 10 ACLF risk did not differ between TIPS and No TIPS, and at scores ≥ 11 TIPS increased the risk of ALCF. Many preexisting ACLFs grade 1 resolved after TIPS placement. The relevant prognostic parameters for this need further elucidation. The data point to a biologic interaction of liver function and TIPS placement with regard to the development of ACLF, which needs further evaluation.

Research conclusions

In selected patients with severely impaired liver function TIPS placement does not result in an increased in-hospital mortality compared to conservatively treated patients. TIPS was associated with ALCF only in patients with severely impaired liver function (Child > 11 points).

Research perspectives

The medical limits of TIPS placement for recurrent tense ascites should be evaluated in prospective studies which need to address the indications, contraindications and the associated complex decision making.