30 Jahre transjugulärer intrahepatischer portosystemischer Shunt (TIPS) – Rückblick und Perspektive

Schultheiß, Michael; Bettinger, Dominik; Thimme, Robert; Rössle, Martin

doi:10.1055/a-1217-7866

Cited by 7 publications

(6 citation statements)

References 115 publications

(115 reference statements)

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“…Transjugular intrahepatic portosystemic shunt (TIPS) implantation is used in the management of complications of portal hypertension [ 1 ]. The procedure is safe and improves transplant-free survival, both in patients with refractory ascitic decompensation and refractory or recurrent variceal bleeding [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Recurrence of Hepatic Encephalopathy after TIPS: Effective Prophylaxis with Combination of Lactulose and Rifaximin

Seifert

Schindler

Schoster

et al. 2021

JCM

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Background: Transjugular intrahepatic portosystemic shunt (TIPS) implantation is an established procedure to treat portal hypertension with hepatic encephalopathy (HE) as a common complication. There is lack of evidence concerning HE prophylaxis after TIPS. Methods: N = 233 patients receiving TIPS between 2011 and 2018 at a German tertiary care center were included. Of them, 21% (n = 49) had a history of HE. The follow-up period was 12 months. The risk factors of post-TIPS HE were analyzed via multivariate analysis. The efficacy of prophylactic medication regimens was studied. The results show that 35.6% (n = 83) received no medication (NM), 36.5% (n = 85) received lactulose monoprophylaxis (LM), 2.6% (n = 6) rifaximin monoprophylaxis (RM) and 25.3% (n = 59) lactulose and rifaximin (LR) of which 64.4% received l-ornithin-l-aspartate (LOLA) additionally (LR + LOLA) and 36.6% did not (LRonly). Results: Multivariate analysis revealed higher age (p = 0.003) and HE episodes prior to TIPS (p = 0.004) as risk factors for HE after TIPS. LM has no prophylactic effect. LR prevents HE recurrence at 1, 3 and 12 months after TIPS (p = 0.003, p = 0.003, p = 0.006) but does not prevent HE in patients with no history of HE (p = 0.234, p = 0.483, p = 0.121). LR prevents HE recurrence compared with LM/NM (25.0% vs. 64.7%, p = 0.007) within 12 months after TIPS, whereas de novo occurrence is unaffected (p = 0.098). The additional administration of LOLA to LR has no benefit (LRonly: 25.0%, LR + LOLA: 29.7%, p = 0.780). Conclusions: Higher age and previous HE are risk factors post-TIPS HE. In patients with HE prior to TIPS, effective prophylaxis of HE is feasible via combination of lactulose and rifaximin with no additional benefit from LOLA.

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Section: Introductionmentioning

confidence: 99%

Recurrence of Hepatic Encephalopathy after TIPS: Effective Prophylaxis with Combination of Lactulose and Rifaximin

Seifert

Schindler

Schoster

et al. 2021

JCM

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“…In addition, TIPSS itself has positive effects on body composition in the long term: TIPSS implantation leads to both weight and muscle gain as well as overall better body composition in malnourished patients with liver cirrhosis, which in turn may improve cognitive deficits 45,46 . In addition, several further risk factors of HE can be improved by TIPSS placement including lower rates of gastrointestinal haemorrhage, hypovolaemia or infections such as SBP 47 . Taken together, sarcopenia should be no exclusion criterion for TIPSS insertion.…”

Section: Post‐tipss Hementioning

confidence: 99%

“…45,46 In addition, several further risk factors of HE can be improved by TIPSS placement including lower rates of gastrointestinal haemorrhage, hypovolaemia or infections such as SBP. 47 Taken together, sarcopenia should be no exclusion criterion for TIPSS insertion. However, sarcopenic patients should be monitored closely for post-TIPSS HE and may be in the highest need of preventive measures.…”

Section: Sarcopenia As a Risk Factor For Post-tipss Hementioning

confidence: 99%

Review article: post‐TIPSS hepatic encephalopathy—current knowledge and future perspectives

Gairing

Müller

Kloeckner

et al. 2022

Aliment Pharmacol Ther

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“…Transjugular intrahepatic portosystemic shunt (TIPS) is performed to reduce portal hypertension and associated complications in patients with decompensated liver cirrhosis [ 1 – 3 ]. The procedure is safe with low rates of complication as a result of major progress in experience and technical ameliorations throughout the last decades [ 4 ]. In patients with refractory ascites, TIPS implantation improves transplant-free survival (TFS) and shows superior results of repetitive large volume paracentesis [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Aspirin improves transplant-free survival after TIPS implantation in patients with refractory ascites: a retrospective multicentre cohort study

et al. 2022

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Background and aims Transjugular intrahepatic portosystemic shunt (TIPS) implantation is an established procedure to treat portal hypertension. Impact of administration of aspirin on transplant-free survival after TIPS remains unknown. Methods A multicenter retrospective analysis including patients with TIPS implantation between 2011 and 2018 at three tertiary German Liver Centers was performed. N = 583 patients were included. Survival analysis was performed in a matched cohort after propensity score matching. Patients were grouped according to whether aspirin was (PSM-aspirin-cohort) or was not (PSM-no-aspirin-cohort) administered after TIPS. Primary endpoint of the study was transplant-free survival at 12 months after TIPS. Results Aspirin improved transplant-free survival 12 months after TIPS with 90.7% transplant-free survival compared to 80.0% (p = 0.001) after PSM. Separated by TIPS indication, aspirin did improve transplant-free survival in patients with refractory ascites significantly (89.6% vs. 70.6% transplant-free survival, p < 0.001), while no significant effect was observed in patients with refractory variceal bleeding (91.1% vs. 92.2% transplant-free survival, p = 0.797). Conclusion This retrospective multicenter study provides first data indicating a beneficial effect of aspirin on transplant-free survival after TIPS implantation in patients with refractory ascites.

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30 Jahre transjugulärer intrahepatischer portosystemischer Shunt (TIPS) – Rückblick und Perspektive

Cited by 7 publications

References 115 publications

Recurrence of Hepatic Encephalopathy after TIPS: Effective Prophylaxis with Combination of Lactulose and Rifaximin

Recurrence of Hepatic Encephalopathy after TIPS: Effective Prophylaxis with Combination of Lactulose and Rifaximin

Review article: post‐TIPSS hepatic encephalopathy—current knowledge and future perspectives

Aspirin improves transplant-free survival after TIPS implantation in patients with refractory ascites: a retrospective multicentre cohort study

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