In refractory ascites, TIPS with covered stents helps avoid transplant

Last Updated: 2016-10-03

By Reuters Staff

NEW YORK (Reuters Health) - Transjugular intrahepatic portosystemic shunting (TIPS) with covered stents prolongs transplant-free survival in cirrhosis patients with recurrent ascites, researchers from France report.

Refractory or recurrent ascites, a severe complication of cirrhosis, is associated with a mean one-year survival of 50%. Fewer than 20% of these patients can undergo liver transplantation, so they are typically treated with repeated large-volume paracentesis (LVP) with albumin infusion.

Several controlled trials have found TIPS to be superior to LVP for refractory ascites, although all these trials used uncovered stents.

Dr. Christophe Bureau from Universite Paul Sabatier Toulouse III, Toulouse, France and colleagues compared the efficacy of TIPS stents covered with polytetrafluoroethylene versus LVP plus albumin infusion (LVP+A) in terms of liver transplantation-free survival in 62 patients with recurrent ascites. Patients expected to undergo transplant within the next six months or on waiting list were excluded.

In most cases, patients' liver disease was alcohol-related.

TIPS insertion was successful in all 29 patients assigned to TIPS, with a decrease in mean portal pressure gradient (PPG) from 15.4 mm Hg to 6.4 mm Hg. All 29 patients achieved a PPG below 12 mm Hg, according to the September 20th Gastroenterology online report.

"Patients in LVP+A group had twice as many days of hospitalization (35 days) as the TIPS group (17 days)," the authors reported.

Two patients in the TIPS group and five of 33 patients in the LVP+A group died during follow-up. None of the patients in the TIPS group and 4 patients in the LVP+A group underwent liver transplantation.

The one-year actuarial transplant-free survival rate was significantly higher with TIPS vs LVP+A (93% vs 52%; p=0.003).

During the year of follow-up, paracentesis was employed far less often in the TIPS group (total, 32; 1.0 per patient) than in the LPV+A group (total, 320; 10.1 per patient). Fifteen patients from the TIPS group required no further paracentesis, compared with none of the patients from the LVP+A group.

The one-year probability of remaining free of overt hepatic encephalopathy was 65% in both groups. Portal hypertension-related bleeding and hernia-related complications were more common in the LVP+A group, whereas spontaneous bacterial peritonitis, hepatorenal syndrome, infection, and hepatocellular carcinoma occurred with similar frequency in both groups.

"TIPS with covered stents improved one-year transplant free survival in selected patients with recurrent ascites and should therefore be preferred to large volume paracenteses with volume expansion," the researchers conclude.

Dr. Bureau did not respond to a request for comments.

Gore Inc. supported the trial and had relationships with 2 of the 11 authors, including Dr. Bureau.

SOURCE: http://bit.ly/2cL4PaT

Gastroenterology 2016.