Long‐term clinical outcome of patients with cirrhosis and refractory ascites treated with transjugular intrahepatic portosystemic shunt insertion

Tan, Han Khim; James, Paul D.; Sniderman, Kenneth W.; Wong, Florence

doi:10.1111/jgh.12725

Cited by 73 publications

(58 citation statements)

References 36 publications

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“…These findings correspond with the results of current literature: in a multicenter, randomized trial including 137 patients, Perarnau et al[12] found that covered stents provided a significant 39% reduction in dysfunction as compared to bare stents [12]. Likewise, Tan et al [25] ascertained that more patients with bare stents developed shunt dysfunction and required TIPS revisions (74.0 vs. 24.1%). In a prospective study including 80 patients, Bureau et al [16] documented similar results after a 2 years follow-up (43.9 vs. 15.0%).…”

Section: Discussionsupporting

confidence: 80%

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Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

Buechter¹,

Manka²,

Gerken³

et al. 2018

Dig Dis

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Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in decompensated portal hypertension. TIPS revision due to thrombosis or stenosis increases morbidity and mortality. Our aim was to investigate patient- and procedure-associated risk factors for TIPS-revision. Patients and Methods: We retrospectively evaluated 189 patients who underwent the TIPS procedure. Only patients who required TIPS revision within 1 year (Group I, 34 patients) and patients who did not require re-intervention within the first year (Group II [control group], 54 patients) were included. Results: Out of 88 patients, the majority were male (69.3%) and mean age was 56 ± 11 years. Indications for TIPS were refractory ascites (68%), bleeding (24%), and Budd-Chiari syndrome (8%). The most frequent liver disease was alcohol-induced cirrhosis (60%). Forty-three patients (49%) received bare and 45 patients (51%) covered stents, thus resulting in reduction of hepatic venous pressure gradient (HVPG) from 19.0 to 9.0 mm Hg. When comparing patient- and procedure-related factors, the type of stent (p < 0.01) and interventionalist’s experience (number of performed TIPS implantations per year; p < 0.05) were the only factors affecting the risk of re-intervention due to stent dysfunction, while age, gender, indication, Child-Pugh, and model of end-stage liver disease score, platelet count, pre- and post-HVPG, additional variceal embolization, stent diameter, and number of stents did not significantly differ. Conclusion: Patients undergoing TIPS procedure should be surveilled closely for shunt dysfunction while covered stents and high-level experience are associated with increased patency.

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Section: Discussionsupporting

confidence: 80%

“…In a prospective study including 80 patients, Bureau et al [16] documented similar results after a 2 years follow-up (43.9 vs. 15.0%). TIPS dysfunction rates depending on stent type according to current literature are demonstrated in Table 4 [12, 16, 25-34]. …”

Section: Discussionmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

Buechter¹,

Manka²,

Gerken³

et al. 2018

Dig Dis

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“…Of note, that in the follow‐up of patients with covered TIPSS, the reintervention rate due to TIPSS dysfunction or hepatic encephalopathy ranges, according to recent reports, from 7% to 42% depending on the duration of follow‐up and technical characteristics of the TIPSS. Moreover, patients with repeat LVP due to RA are regularly seen in out‐patient clinics or, depending on the respective country, even require short hospitalisations for the treatment of the ascites.…”

Section: Discussionmentioning

confidence: 99%

Treatment of refractory ascites with an automated low‐flow ascites pump in patients with cirrhosis

Stirnimann¹,

Berg²,

Zeuzem³

et al. 2017

Aliment Pharmacol Ther

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SummaryBackgroundRefractory ascites (RA) is a frequent complication of cirrhosis, requiring large volume paracentesis or placement of a transjugular intrahepatic portosystemic shunt (TIPSS). The automated low‐flow ascites pump (alfapump, Sequana Medical AG, Zurich, Switzerland) is an innovative treatment option for patients with RA.AimTo assess safety and efficacy of this treatment in patients with a contraindication to TIPSS.MethodsFifty‐six patients (43 males; mean age 62 years) from centres in Germany, Switzerland, UK and Spain were included and followed for up to 24 months. Complications, device deficiencies, paracentesis frequency and patient survival were recorded.ResultsAt the time of this analysis, 3 patients completed the 24‐month observation period, monitoring of 3 was ongoing, 9 underwent liver transplantation, 17 patients were withdrawn due to serious adverse events and 23 patients died. Most frequently observed technical complication was blocking of the peritoneal catheter. Twenty‐three pump‐related reinterventions (17 patients) and 12 pump exchanges (11 patients) were required during follow‐up. The pump system was explanted in 48% of patients (in 17 patients due to serious adverse events, in 9 at the time of liver transplantation and in 1 due to recovery from RA). Median frequency of paracentesis dropped from 2.17 to 0.17 per month.ConclusionsThe alfapump can expand therapeutic options for cirrhotic patients with RA. Continuous drainage of ascites in a closed loop automated system led to significant reduction in paracentesis frequency. Technical and procedural improvements are required to reduce the rate of adverse events and reinterventions. https://clinicaltrials.gov/ct2/show/NCT01532427

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“…Prior to the reimbursement of tolvaptan therapy in Japan, dose escalation of spironolactone, loop and thiazide diuretics had been the first-choice strategy for the medical management of patients with refractory ascites, despite its associations with glomerular damage and hyponatremia (3). Although abdominal paracentesis with drainage, cell-free and concentrated ascites reinfusion therapy and trans-jugular intrahepatic portosystemic shunt placement are occasionally used, results suggest that these procedures do not improve overall prognosis (18)(19)(20). Tolvaptan may delay the need for invasive procedures and readmission for patients with refractory ascites.…”

Section: Univariate Analysismentioning

confidence: 99%

Tolvaptan is effective in treating patients with refractory ascites due to cirrhosis

et al. 2017

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Abstract. The treatment of refractory ascites due to cirrhosis is a clinical challenge for hepatologists. Tolvaptan, a novel aquaporin modulator, was made available in Japan in 2013 for the treatment of patients with refractory ascites due to cirrhosis. Despite the potential of this drug, few reports are available regarding its clinical use. The aim of the present study was to clarify the efficacy of tolvaptan in patients with refractory ascites due to cirrhosis and to review the clinical outcomes of treatment. Medical records were retrospectively reviewed for 65 patients with refractory ascites due to cirrhosis who were treated daily with 7.5 mg tolvaptan. The median follow-up time, defined as the period between starting tolvaptan and the last clinic visit or date of mortality, was 175 days (interquartile range 56-406). After one week of tolvaptan treatment, the mean weight reduction was 3.4 kg, with a response rate of 69% (45/65). Subsequently, factors associated with the response to tolvaptan were analyzed. On univariate analysis, maintaining serum sodium (Na) ≥140 mEq/l and an estimated glomerular filtration rate (eGFR) ≥55 ml/min were significant predictors of response (P<0.05). On multivariate analysis, hepatitis C virus etiology, maintaining serum Na ≥140 mEq/l and an eGFR ≥55 ml/min were significant predictors of response (P<0.05). Factors associated with survival were also analyzed using the Cox proportional hazard model. On multivariate analysis, responsiveness to tolvaptan was a predictor of long-term survival (P=0.002), and hyperbilirubinemia was associated with short-term survival (P=0.028). Additionally, KaplanMeier analysis with a log-rank test indicated longer survival times in tolvaptan responders than non-responders (P=0.011).In conclusion, tolvaptan was effective in treating patients with refractory ascites due to cirrhosis. In particular, tolvaptan treatment was highly effective for patients with hepatitis C virus etiology and normal serum Na and renal function. Furthermore, response to tolvaptan was associated with longer survival time while hyperbilirubinemia was associated with shorter survival time.

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Long‐term clinical outcome of patients with cirrhosis and refractory ascites treated with transjugular intrahepatic portosystemic shunt insertion

Cited by 73 publications

References 36 publications

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

Treatment of refractory ascites with an automated low‐flow ascites pump in patients with cirrhosis

Tolvaptan is effective in treating patients with refractory ascites due to cirrhosis

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