ePTFE-TIPS versus repetitive LVP plus albumin for the treatment of refractory ascites in patients with cirrhosis

TA Bucsics; S Hoffmann; J Grünberger; M Schoder; W Matzek; M Mandorfer; P Schwabl; A Ferlitsch; M Peck-Radosavljevic; M Trauner; J Karner; F Karnel; T Reiberger

doi:10.1055/s-0037-1603405

Zeitschrift für Gastroenterologie, Inhaltsverzeichnis

Z Gastroenterol 2017; 55(05): e28-e56
DOI: 10.1055/s-0037-1603405

Hepatologie

Georg Thieme Verlag KG Stuttgart · New York

ePTFE-TIPS versus repetitive LVP plus albumin for the treatment of refractory ascites in patients with cirrhosis

Authors

TA Bucsics

¹Medical University of Vienna, Dpt. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
S Hoffmann

¹Medical University of Vienna, Dpt. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
J Grünberger

¹Medical University of Vienna, Dpt. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
M Schoder

²Dept. of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
W Matzek

²Dept. of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
M Mandorfer

¹Medical University of Vienna, Dpt. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
P Schwabl

¹Medical University of Vienna, Dpt. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
A Ferlitsch

¹Medical University of Vienna, Dpt. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
M Peck-Radosavljevic

³Department of Gastroenterology and Hepatology, Endocrinology, and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurth, Austria
M Trauner

¹Medical University of Vienna, Dpt. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
J Karner

⁴Dept. of Surgery, Kaiser-Franz Josef Spital, Vienna, Austria
F Karnel

⁵Dept. of Radiology, Kaiser-Franz Josef Spital, Vienna, Austria
T Reiberger

¹Medical University of Vienna, Dpt. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria

Abstract

Volltext

Introduction:

Portal pressure reduction by self-expandable polytetrafluoroethylene (ePTFE)-covered transjugular intrahepatic portosystemic shunts (TIPS) is a treatment option for patients with refractory ascites. Data on the outcomes after ePTFE-TIPS versus repetitive large-volume paracentesis (LVP) plus albumin (A) administration for the treatment of refractory ascites are limited.

Methods:

Retrospective comparison of ePTFE-TIPS versus LVP+A in terms of (i) control of ascites, (ii) occurrence of overt hepatic encephalopathy (HE) and (iii) transplant-free survival in cirrhotic patients with refractory ascites.

Results:

Among n = 221 patients with cirrhosis and refractory ascites, n = 140 received ePTFE-TIPS and were compared to n = 71 undergoing repetitive LVP+A. After ePTFE-TIPS, ascites was controlled without need for paracentesis in n = 76 (54%; n = 7 without and n = 69 with diuretics). The need for frequent large-volume paracentesis was significantly higher in the LVP+A group than with ePTFE-TIPS (median 0.67 (IQR 0.23 – 2.63) months vs. 49.5 (IQR 5.07 – 102.60) months until paracentesis, log-rank p < 0.001). De-novo incidence of overt HE was similar between ePTFE-TIPS and LVP+A patients (log-rank p = 0.361). Implantation of ePTFE-TIPS was associated with improved 1-year survival as compared to LVP+A (65.6% vs. 48.4%, log-rank p = 0.033). However, only age (odds ratio (OR): 1.05; 95% confidence interval (95% CI): 1.03 – 1.07; p < 0.001), serum albumin (OR: 0.95; 95% CI: 0.92 – 0.99; p = 0.013) and hepatocellular carcinoma (OR: 1.66; 95% CI: 1.06 – 2.58; p = 0.026) emerged as independent predictors of survival.

Conclusions:

ePTFE-TIPS results in superior control of refractory ascites without increasing the incidence of overt HE as compared to LVP+A. Although ePTFE-TIPS improved the 1-year survival in cirrhotic patients with refractory ascites, its use was not independently associated with transplant-free survival.