Predictive factors for improvement of ascites after transjugular intrahepatic portosystemic shunt in patients with refractory ascites

Taki, Yasuhiko; Kanazawa, Hideko; Narahara, Yoshiyuki; Itokawa, Norio; Kondo, Chisa; Fukuda, Takahiro; Harimto, Hirotomo; Matsushita, Yasuyuki; Kidokoro, Hideko; Katakura, Tamaki; Atsukawa, Masanori; Kimura, Yuu; Nakatsuka, Katsuhisa; Sakamoto, Choitsu

doi:10.1111/hepr.12195

Cited by 17 publications

(11 citation statements)

References 25 publications

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“…Also, the careful selection of candidates for TIPS among patients with cirrhosis and refractory ascites improves the results of the operation. The adverse outcome after TIPS is found in CTP class C patients[97] with the following: (1) MELD score > 25 points and a portosystemic gradient < 8 mmHg[98]; (2) INR value > 2[99]; (3) Total serum bilirubin level > 3 mg/dL and platelet count < 75 × 10 9 /L[100]; (4) Serum creatinine level > 1.9 mg/dL[101]; (5) Glomerular filtration rate < 90 mL/min and platelet count < 125 × 10 9 /L[102]; (6) Recurrent hepatic encephalopathy, which equals or exceeds the 2 nd stage[103]; and (7) Diastolic dysfunction (E/A ratio ≤ 1)[104].…”

Section: Treatment Of Ascites In Patients With Cirrhosismentioning

confidence: 99%

Current approaches to the management of patients with cirrhotic ascites

Garbuzenko¹,

Arefyev²

2019

WJG

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This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords: “liver cirrhosis,” “portal hypertension,” “ascites,” “pathogenesis,” “diagnostics,” and “treatment.” Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.

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Section: Treatment Of Ascites In Patients With Cirrhosismentioning

confidence: 99%

Current approaches to the management of patients with cirrhotic ascites

Garbuzenko¹,

Arefyev²

2019

WJG

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“…ePTFE‐covered TIPS seem to be superior to previously used, uncoated metal stents with regard to patency and stent dysfunction . Although TIPS using bare stents showed good results for controlling refractory ascites in previous trials, data on the effectiveness of ePTFE‐covered TIPS was scarce …”

Section: Introductionmentioning

confidence: 98%

“…ePTFE-covered TIPS seem to be superior to previously used, uncoated metal stents with regard to patency and stent dysfunction. 19,22,25,26 Although TIPS using bare stents showed good results for controlling refractory ascites in previous trials, [27][28][29][30] data on the effectiveness of ePTFE-covered TIPS was scarce. 31,32 Recently, Bureau et al 33 published a prospective randomized controlled trial comparing ePTFE-TIPS vs LVP+A in 62 patients with severe and/or recurrent ascites, and found increased transplant-free survival (TFS) in the TIPS group while the risk of developing HE was similar.…”

Section: Introductionmentioning

confidence: 99%

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

Bucsics

Hoffman

Grünberger

et al. 2018

Liver International

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“…Dig Dis 2020;38:320-328 DOI: 10.1159/000503559 Subsequently, sympathetic nervous system and vasoconstrictor factors, especially arginine-vasopressin and renin-angiotensin-aldosterone axis are homeostatically activated, leading to sodium retention and impaired freewater excretion [3]. Conventional management mainly includes a salt-restricted diet in conjunction with the administration of loop diuretics and spironolactone [4]; however, refractory ascites develops in up to 10% of patients [5], as a consequence of a lack of response despite intensive diuretic therapy or the inability to reach effective doses due to adverse effects, such as renal impairment, electrolyte disturbances, and hepatic encephalopathy [6].…”

Section: Introductionmentioning

confidence: 99%

“…Recent research has proposed the promising role of tolvaptan as an add-on treatment in patients with hepatic ascites resistant to conventional diuretics, as it is able to decrease body weight, alleviate edema [6], and ameliorate long-term outcomes [11]. Nevertheless, its potency varies widely, since not all patients benefit the same from its administration [12].…”

Section: Introductionmentioning

confidence: 99%

Tolvaptan Response Improves Overall Survival in Patients with Refractory Ascites: A Meta-Analysis

Bellos¹,

Kontzoglou²,

Psyrri³

et al. 2019

Dig Dis

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Background and Aims: Refractory ascites represents a significant complication of decompensated cirrhosis, associated with increased mortality rates. The aim of this meta-analysis was to evaluate whether response to treatment with tolvaptan is associated with improved overall survival in cirrhotic patients with refractory ascites. Methods: Medline, Scopus, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and Google Scholar databases were systematically searched from inception to April 11, 2019. All studies that assessed the overall survival of patients with ascites depending on their response to tolvaptan were held eligible. Results: Nine studies were included, with a total of 736 patients with cirrhosis and ascites. Response to tolvaptan was estimated to be linked to significantly improved overall survival (hazard ratio [HR] 0.42, 95% CI [0.31-0.58]). Subgroup analysis indicated that the same outcome was present when tolvaptan responsiveness was defined either as effective body weight loss (HR 0.44, 95% CI [0.30-0.63] or as effective sodium restoration (HR 0.35,]. Sensitivity analysis suggested that the presence of hepatocellular carcinoma, the sample size, and the quality of the studies did not significantly affect the overall result of the meta-analysis. Conclusions:The outcomes of the meta-analysis support the prognostic role of tolvaptan response in patients with cirrhosis and refractory ascites, as it was shown to lead to significantly improved overall survival. These findings should be confirmed by future large-scale studies, while efficient biomarkers should be identified in order to accurately predict response to tolvaptan and discriminate patients that would benefit from its administration.

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Predictive factors for improvement of ascites after transjugular intrahepatic portosystemic shunt in patients with refractory ascites

Abstract: A low serum creatinine level in patients with refractory ascites is associated with an early response to TIPS. An early response of ascites to TIPS provides better survival. A serum creatinine level below 1.9 mg/dL is required for a good response to TIPS.

Cited by 17 publications

References 25 publications

Current approaches to the management of patients with cirrhotic ascites

Current approaches to the management of patients with cirrhotic ascites

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

Tolvaptan Response Improves Overall Survival in Patients with Refractory Ascites: A Meta-Analysis

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