Safety and feasibility of transjugular intrahepatic portosystemic shunt in elderly patients with liver cirrhosis and refractory ascites

Stockhoff, Lena; Schultalbers, Marie; Tergast, Tammo L.; Hinrichs, Jan B.; Gerbel, Svetlana; Meine, Timo C; Manns, Michael P.; Simon, N.; Cornberg, Markus; Meyer, Bernhard; Maasoumy, Benjamin

doi:10.1371/journal.pone.0235199

Cited by 8 publications

(14 citation statements)

References 44 publications

(48 reference statements)

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“…To compare patients with PeCa implant to SOC, patients with RA were recruited from a large registry that includes patients with decompensated liver cirrhosis and ascites between 2012 and 2018 (SOC Cohort). Detailed information about the cohort is described elsewhere 16,17 and included patients fulfilled the same criteria as the PeCa patients (Figure 1). At our centre, patients with RA and SOC received repeated large volume paracentesis and albumin infusion according to current guidelines.…”

Section: Study Cohortmentioning

confidence: 99%

Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Tergast

Griemsmann

Stockhoff

et al. 2022

Aliment Pharmacol Ther

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Summary Background Onset of refractory ascites is the hallmark of end‐stage liver disease. If liver transplantation (LTx) is not available and contraindications for a transjugular portosystemic shunt (TIPS) are present, repeated paracentesis remains the standard of care (SOC). Home‐based, tunnelled peritoneal catheters (PeCa) have been suggested as an alternative treatment option. However, data on patients with cirrhosis are scarce. Aim To evaluate the safety of PeCa in these patients compared to SOC. Methods Overall, 223 patients with cirrhosis, a contraindication for TIPS and refractory ascites were included in this retrospective study. PeCa implant was performed in 152 patients, whereas 71 were treated with SOC. Analysed end points included device explant‐free survival, mortality, acute kidney injury (AKI) and hyponatraemia. In the second approach, propensity score matching (PPSM) was performed to adjust for confounding factors. Results In patients with PeCa, median device explant‐free survival was 74 days and 52 explants were recorded within the first 90 days. Within 90 days, patients with PeCa had lower mortality than SOC (p = 0.11), and spontaneous bacterial peritonitis (SBP) incidence did not differ (p = 0.82). Regarding AKI and hyponatraemia, there was a trend towards a higher incidence in the PeCa group (p = 0.13 and p = 0.08), and the risk for rehospitalisation was higher in those with a PeCa (HR: 2.11, p = 0.04). After PPSM, mortality was lower in the PeCa group (HR:0.40; p = 0.03), whereas the incidence of SBP and hyponatraemia was comparable (p = 0.80 and p = 0.28) and AKI was more frequent in those with a PeCa (p = 0.08). Conclusion The implant of PeCa allows home‐based therapy of patients with cirrhosis and refractory ascites and a contraindication for TIPS. However, the risk for complications has to be considered and prospective studies are needed.

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Section: Study Cohortmentioning

confidence: 99%

Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Tergast

Griemsmann

Stockhoff

et al. 2022

Aliment Pharmacol Ther

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“…We performed propensity score matching to match patients with refractory/recurrent ascites treated with either TIPS or paracentesis. 2 Only patients without an established TIPS contraindication were considered for the matching. 4 In the first matching only high risk patients (FIPS ≥0.64) and in the second matching only low risk patients (FIPS <0.64) were included from both cohorts.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

“…1). 2 The Hannover Ascites Cohort includes >600 patients with decompensated liver cirrhosis and ascites. A number of 528 patients did not receive a TIPS during follow up and was used as a control group (baseline characteristics: Supplementary Tab.…”

mentioning

confidence: 99%

Freiburg index of post-TIPS survival (FIPS) a valid prognostic score in patients with cirrhosis but also an advisor against TIPS?

Stockhoff

Schneider

Tergast

et al. 2021

Journal of Hepatology

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“…Interestingly, the protective effect of aspirin on transplant-free survival occurs early after TIPS procedure. This may be explainable due the mortality being highest within the first 100 days after TIPS insertion specifically in patients with refractory ascites [ 31 ]. Causes of death were not analyzed separately in the presented study due to unavailability of data.…”

Section: Discussionmentioning

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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Safety and feasibility of transjugular intrahepatic portosystemic shunt in elderly patients with liver cirrhosis and refractory ascites

Cited by 8 publications

References 44 publications

Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Freiburg index of post-TIPS survival (FIPS) a valid prognostic score in patients with cirrhosis but also an advisor against TIPS?

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

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