Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11313
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
Processing time: 159 Days and 6.1 Hours
Refractory ascites has a 1-year survival rate of 50%. In selected patients, treatment options include liver transplantation (LT) or transjugular intrahepatic porto
To assess the outcomes of patients who underwent a TIPSS compared to large volume paracentesis (LVP).
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).
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.
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.