Effects of ascites resolution after successful TIPS on nutrition in cirrhotic patients with refractory ascites

Allard, Johane P.; Chau, Jenny Fung Ling; Sandokji, Karim; Blendis, Laurie; Wong, Florence

doi:10.1111/j.1572-0241.2001.04051.x

Cited by 90 publications

(60 citation statements)

References 40 publications

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“…Nutritional status as measured by prealbumin improved with alfapump therapy as early as 3 months after pump implantation, similar to what was observed in studies following alfapump insertion or TIPS . Anecdotally, patients put on more fat and muscle weight.…”

Section: Discussionsupporting

confidence: 77%

Improvement in Quality of Life and Decrease in Large‐Volume Paracentesis Requirements With the Automated Low‐Flow Ascites Pump

Bendel¹,

Sniderman

Frederick³

et al. 2020

Liver Transpl

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The automated low-flow ascites pump (alfapump) is an implantable device that drains ascites directly into the urinary bladder. We studied its safety (absence of serious complications) and efficacy (decreased large-volume paracentesis [LVP] requirement and improved quality of life [QoL]) in the management of ascites in a cohort of North American patients with cirrhosis and recurrent ascites ineligible for transjugular intrahepatic portosystemic shunt (TIPS). QoL was measured by the Chronic Liver Disease Questionnaire (CLDQ) and Ascites Questionnaire (Ascites Q). Following alfapump implantation, patients were monitored for ascites control, laboratory abnormalities, QoL, adverse events, and survival at 12 months. A total of 30 patients (60.0 ± 9.9 years; 57% male; Model for End-Stage Liver Disease score, 11.4 ± 2.7) received an alfapump, mostly by an interventional radiology approach (97%), followed by longterm prophylactic antibiotics. The alfapump removed a mean ascites volume of 230.6 ± 148.9 L/patient at 12 months, dramatically reducing the mean LVP frequency from 2.4 ± 1.4/patient/month before pump implantation to 0.2 ± 0.4/patient/month after pump implantation. All surviving patients had improved QoL (baseline versus 3 months; CLDQ, 3.9 ± 1.21 versus 5.0 ± 1.0; Ascites Q, 51.7 ± 21.9 versus 26.7 ± 18.6; P < 0.001 for both) and a better biochemical index of nutritional status (prealbumin 87.8 ± 37.5 versus 102.9 ± 45.3 mg/L at 3 months; P = 0.04). Bacterial infections (15 events in 13 patients), electrolyte abnormalities (11 events in 6 patients), and renal complications (11 events in 9 patients) were the most common severe adverse events. By 12 months, 4 patients died from complications of cirrhosis. Alfapump insertion may be a definitive treatment for refractory ascites in cirrhosis, especially in patients who are not TIPS candidates.Liver Transplantation 26 651-661 2020 AASLD. standard deviation; TIPS, transjugular intrahepatic portosystemic shunt; UTI, urinary tract infection; WBC, white blood cells.Address reprint requests to Florence Wong, M.B., B.

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Section: Discussionsupporting

confidence: 77%

Improvement in Quality of Life and Decrease in Large‐Volume Paracentesis Requirements With the Automated Low‐Flow Ascites Pump

Bendel¹,

Sniderman

Frederick³

et al. 2020

Liver Transpl

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“…A protein‐losing enteropathy has been described in cirrhotic patients with portal hypertension but its role is not so cleaE . Indeed, the amelioration of the nutritional status observed after the resolution of portal hypertension induced by TIPS, support a link between portal hypertension and sarcopenia . Finally, portal hypertension leading to episodes of gastrointestinal bleeding or ascites may determine hospitalizations and states of illness that can determine a worsening in nutritional status and muscle mass.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and impact of sarcopenia in non‐cirrhotic portal hypertension

Lattanzi

Gioia

Cola

et al. 2019

Liver International

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should be considered joint first authors Abbreviations: INCPH, idiopathic non-cirrhotic portal hypertension; NCPH, non-cirrhotic portal hypertension; PPG, portal pressure gradient; PVT, portal vein thrombosis; SMI, skeletal muscle index; TIPS, transjugular intrahepatic portosystemic shunt. Abstract Background & Aims: Little is known on nutritional parameters in patients with chronic portal vein thrombosis (PVT) and idiopathic non-cirrhotic portal hypertension (INCPH). The study aims to assess the prevalence and the clinical impact of sarcopenia in patients with non-cirrhotic portal hypertension (NCPH). A control group of cirrhotic patients was also studied. Both groups were followed up to establish the relationship between sarcopenia and clinical outcomes. Methods: Sixty-seven patients with NCPH (51 PVT and 16 INCPH) were included in the study group and 104 patients with liver cirrhosis in the control group. The axial plane passing through the intersomatic disk between L3 and L4 was evaluated for the quantitative analysis of muscle mass and the skeletal muscle index (SMI) was calculated. The presence of sarcopenia was established according to SMI validated cut off.Results: Sarcopenia was present in the 38% of patients with INCPH, 35% of patients with chronic PVT, 32% of patients with compensated cirrhosis and 54% of decompensated cirrhotics. During a mean follow-up of 51 ± 62 months, there was no difference in sarcopenic and non-sarcopenic patients with NCPH for incidence of ascites, hepatic encephalopathy, esophageal varices, variceal bleeding and death. However, the incidence of refractory variceal bleeding requiring TIPS placement was significantly higher in comparison with the non-sarcopenic ones (29% vs 7%, P = 0.01 at log-rank test). Conclusions:In patients with NCPH sarcopenia is similar to that observed in cirrhotic patients. Moreover, the rate of refractory variceal bleeding was higher in sarcopenic patients suggesting a clinical negative impact of muscle depletion. K E Y W O R D Snon-cirrhotic portal hypertension, portal vein thrombosis, sarcopenia, skeletal muscle index

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“…TIPS has been shown to exert a direct effect on body composition and other markers of nutritional status . A study evaluated 57 patients undergoing TIPS placement and 32 matched patients with cirrhosis without TIPS.…”

Section: Interventions Targeting Sarcopenia and Physical Fitnessmentioning

confidence: 99%

“…TIPS has been shown to exert a direct effect on body composition and other markers of nutritional status. (63) A study evaluated 57 patients undergoing TIPS placement and 32 matched patients with cirrhosis without TIPS. After a mean follow-up of 14 6 12 months, total psoas and paraspinal CT muscle area increased significantly only in the TIPS group.…”

Section: Transjugular Intrahepatic Portosystemic Shuntmentioning

confidence: 99%

Exercise and physical activity for patients with end‐stage liver disease: Improving functional status and sarcopenia while on the transplant waiting list

Duarte‐Rojo¹,

et al. 2017

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and physical deconditioning are frequent complications in patients with cirrhosis and end-stage liver disease (ESLD). They are the end result of impaired dietary intake, chronic inflammation, altered macronutrient and micronutrient metabolism, and low physical activity. Frailty is the end result of prolonged sarcopenia and physical deconditioning. It severely affects a patient's functional status and presents in approximately 1 in 5 patients on the liver transplantation waiting list. Sarcopenia, poor physical fitness/cardiopulmonary endurance (CPE), and frailty are all associated with increased mortality in ESLD. Clinical trials addressing the usefulness of exercise in patients with cirrhosis have shown that it improves the metabolic syndrome, sarcopenia, CPE, health-related quality of life, and hepatic venous pressure gradient. Although evidence on the benefits of exercise on clinical outcomes derived from large clinical trials is still missing, based on existing literature from multiple medical subspecialties, we believe that an exercise program coupled to a tailored nutritional intervention benefits both cardiopulmonary and musculoskeletal functions, ultimately translating into improved functional status, sense of well-being, and possibly less complications from portal hypertension. In conclusion, although supervised exercise training is the prevailing approach to manage ESLD patients, such intervention is not sustainable or feasible for most patients. Innovative home-based physical activity interventions may be able to effectively reach a larger number of patients.Liver Transplantation 24 122-139 2018 AASLD.

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Effects of ascites resolution after successful TIPS on nutrition in cirrhotic patients with refractory ascites

Abstract: In cirrhotic patients with refractory ascites, resolution of the ascites after TIPS placement resulted in improvement of several nutritional parameters, especially for body composition.

Cited by 90 publications

References 40 publications

Improvement in Quality of Life and Decrease in Large‐Volume Paracentesis Requirements With the Automated Low‐Flow Ascites Pump

Improvement in Quality of Life and Decrease in Large‐Volume Paracentesis Requirements With the Automated Low‐Flow Ascites Pump

Prevalence and impact of sarcopenia in non‐cirrhotic portal hypertension

Exercise and physical activity for patients with end‐stage liver disease: Improving functional status and sarcopenia while on the transplant waiting list

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