Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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, Homoyoon Merhzad, Salil Karkhanis, Dhiraj Tripathi
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
Processing time: 159 Days and 6.1 Hours
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.

Keywords: Portal hypertension; Liver cirrhosis; Transjugular intrahepatic portosystemic shunt; Ascites; Large volume paracentesis

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.