TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis

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

doi:10.1016/j.jhep.2023.04.028

Cited by 32 publications

(18 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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 .…”

mentioning

confidence: 97%

“…[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. Currently, less than 15% of patients presenting first variceal bleeding die as a result of bleeding (within the first 42 days), while at 1 year, mortality is double, and most deaths occur after developing further decompensation.…”

mentioning

confidence: 99%

See 2 more Smart Citations

The hidden face of preemptive TIPS

Villanueva

2023

Hepatology

View full text Add to dashboard Cite

mentioning

confidence: 55%

mentioning

confidence: 97%

mentioning

confidence: 99%

See 1 more Smart Citation

The hidden face of preemptive TIPS

Villanueva

2023

Hepatology

View full text Add to dashboard Cite

“…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 TIPS placement could either obviate the need of LT as well decrease the risk of death while on the waiting list and should be systematically discussed in its common indication.…”

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

View full text Add to dashboard Cite

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.

show abstract

“… 2 Systemic inflammation is mainly related to the development of AD and ACLF, with a continuous increase of systemic inflammation surrogates across AD and ACLF grades (number of organ failures). 4 However, it must be mentioned that treatment of portal hypertension using transjugular intrahepatic portosystemic shunt (TIPS) may prevent further decompensation 6 and thereby NAD/AD and organ failures.…”

Section: Introductionmentioning

confidence: 99%

Recent advances in the prevention and treatment of decompensated cirrhosis and acute-on-chronic liver failure (ACLF) and the role of biomarkers

Trebicka,

Hernaez,

Shawcross

et al. 2024

Gut

View full text Add to dashboard Cite

The progression of cirrhosis with clinically significant portal hypertension towards decompensated cirrhosis remains clinically challenging and the evolution towards acute-on-chronic liver failure (ACLF), with one or more extrahepatic organ failures, is associated with very high mortality. In the last decade, significant progress has been made in the understanding of the mechanisms leading to decompensation and ACLF. As portal hypertension advances, bacterial translocation across an impaired gut barrier culminates in endotoxaemia, systemic inflammation and cirrhosis-associated immune dysfunction (CAID). Gut-derived systemic inflammation and CAID have become the logical targets for innovative therapies that prevent hepatic decompensation episodes and the progression to ACLF.Furthermore, classification of disease and biomarker discovery to personalise care have advanced in the field. This review discusses progress in biomarker discovery and personalisation of treatment in decompensated cirrhosis and ACLF.

show abstract

TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis

Cited by 32 publications

References 36 publications

The hidden face of preemptive TIPS

The hidden face of preemptive TIPS

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

Recent advances in the prevention and treatment of decompensated cirrhosis and acute-on-chronic liver failure (ACLF) and the role of biomarkers

Contact Info

Product

Resources

About