Covered TIPS reduces the risk of further decompensation: results from an individual patient data meta-analysis of 3924 patients with cirrhosis

Larrue, Hélène; Olivas, Pol; Lv, Yong; Han, Guohong; Bucsics, Theresa; Reiberger, T; Sauerbruch, Tilman; Hernández‐Gea, Virginia; Thabut, Dominique; Rudler, Marika; Péron, Jean Marie; D’Amico, Gennaro; Pagán, Juan Carlos García; Bureau, Christophe

doi:10.1016/s0168-8278(22)01577-x

Cited by 6 publications

(10 citation statements)

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“…This is a key point since further decompensation very markedly increases the risk of death, as nicely demonstrated recently by a large cohort study 7 . Certainly, the last commented IPD-MA showed (as expected) an increased risk of encephalopathy with TIPS 8 . However, this was absolutely offset by a much lower incidence of both rebleeding and ascites favoring TIPS.…”

mentioning

confidence: 55%

“…Such a positive effect is not a minor issue since ascites is the most common and severe decompensating event, both in compensated and in decompensated patients, even in those presenting with variceal bleeding 4,7 . Concordantly, another recent IPD-MA shows that TIPS effectively prevents further decompensation in cirrhosis, 8 which in the last Baveno-VII conference was defined as a second or a recurrent or complicated decompensating event. This is a key point since further decompensation very markedly increases the risk of death, as nicely demonstrated recently by a large cohort study 7 .…”

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confidence: 97%

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The hidden face of preemptive TIPS

Villanueva

2023

Hepatology

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mentioning

confidence: 55%

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confidence: 97%

The hidden face of preemptive TIPS

Villanueva

2023

Hepatology

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“…At least one fifth of patients receiving NSBBs and ligation for prevention of rebleeding in the end was transferred to TIPS for refractory ascites ( 76 , 123 ). In a recent meta-analysis, using individual patient data analysis in nearly 4,000 patients, TIPS proved superior to standard of care for rebleeding–which is in most patients ligation and NSBBs–and also with respect to further decompensation and even survival, the latter mainly due to the cohorts receiving pre-emptive TIPS after a variceal bleeding episode ( 125 ).…”

Section: Indications For Nsbbs Results From Randomized Trialsmentioning

confidence: 99%

“…In this respect it is noteworthy that insertion of a covered TIPS, which achieves the most effective drop of portal pressure has a higher impact on survival than standard of care (ligation and NSBBs). However, this was mainly due to TIPS placement in early temporal relationship to bleeding ( 125 ), while elective TIPS does not improve survival compared to drugs ( 76 , 123 ). It remains an open question in this setting, whether hemodynamic non-responders (HVPG) profit from continuation of NSBBs treatment with respect to survival ( 136 ).…”

Section: Indications For Nsbbs Results From Randomized Trialsmentioning

confidence: 99%

Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?

et al. 2023

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With increasing decompensation, hyperdynamic circulatory disturbance occurs in liver cirrhosis despite activation of vasoconstrictors. Here, the concept of a therapy with non-selective beta-blockers was established decades ago. They lower elevated portal pressure, protect against variceal hemorrhage, and may also have pleiotropic immunomodulatory effects. Recently, the beneficial effect of carvedilol, which blocks alpha and beta receptors, has been highlighted. Carvedilol leads to “biased-signaling” via recruitment of beta-arrestin. This effect and its consequences have not been sufficiently investigated in patients with liver cirrhosis. Also, a number of questions remain open regarding the expression of beta-receptors and its intracellular signaling and the respective consequences in the intra- and extrahepatic tissue compartments. Despite the undisputed role of non-selective beta-blockers in the treatment of liver cirrhosis, we still can improve the knowledge as to when and how beta-blockers should be used in which patients.

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“…Some have already been reported to improve the outcome of patients with AD and ACLF. Albumin infusion has been shown to improve survival in selected patients with refractory ascites and transjugular intrahepatic portosystemic shunt (TIPS) insertion is associated with a decreased risk of further decompensation and death 56,57 . Notably, in the context of acute variceal hemorrhage, pre‐emptive TIPS was associated with improved outcome even in the context of ACLF 55 .…”

Section: Clinical Implicationmentioning

confidence: 99%

Acute decompensation of cirrhosis versus acute‐on‐chronic liver failure: What are the clinical implications?

Xu,

Chen,

Artru

2024

UEG Journal

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It is essential to identify the subgroup of patients who experience poorer outcomes in order to adapt clinical management effectively. In the context of liver disease, the earlier the identification occurs, the greater the range of therapeutic options that can be offered to patients. In the past, patients with acute decompensation (AD) of chronic liver disease were treated as a homogeneous group, with emphasis on identifying those at the highest risk of death. In the last 15 years, a differentiation has emerged between acute‐on‐chronic liver failure syndrome (ACLF) and AD, primarily due to indications that the latter is linked to a less favorable short‐term prognosis. Nevertheless, the definition of ACLF varies among the different knowledge societies, making it challenging to assess its true impact compared with AD. Therefore, the purpose of this review is to provide a detailed analysis emphasizing the critical importance of identifying ACLF in the field of advanced liver disease. We will discuss the differences between Eastern and Western approaches, particularly in relation to the occurrence of liver failure and disease onset. Common characteristics, such as the dynamic nature of the disease course, will be highlighted. Finally, we will focus on two key clinical implications arising from these considerations: the prevention of ACLF before its onset and the clinical management strategies once it develops, including liver transplantation and withdrawal of care.

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Covered TIPS reduces the risk of further decompensation: results from an individual patient data meta-analysis of 3924 patients with cirrhosis

Cited by 6 publications

References 0 publications

The hidden face of preemptive TIPS

The hidden face of preemptive TIPS

Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?

Acute decompensation of cirrhosis versus acute‐on‐chronic liver failure: What are the clinical implications?

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