Clinical

Intrahepatic shunt improves survival in cirrhotic patients with ascites

Last Updated: 2007-10-11 11:50:42 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Compared to paracentesis, employment of a transjugular intrahepatic portosystemic shunt (TIPS) can improve the survival rates in certain liver cirrhosis patients who have difficult-to-treat ascites, according to pooled data from randomized trials.

"TIPS is a treatment of refractory ascites in cirrhotic patients" lead investigator Dr. Francesco Salerno told Reuters Health, "which can improve survival as well as the quality of life."

"Doctors must be careful, however, with TIPS," he added, "because it is not applicable to all patients."

Dr. Salerno of the University of Milan, Italy and colleagues conducted a meta-analysis of data from 4 recent studies in which a total of 149 patients were allocated to TIPS and the remaining 156 underwent paracentesis. The findings are reported in the September issue of Gastroenterology.

Tense ascites recurred in 42% of the TIPS patients and 89% of those given paracentesis p < 0.0001). "Sixty-five of the TIPS patients and 78 of the paracentesis patients died. However, the actuarial probability of transplant-free survival was significantly greater in the TIPS group.

The average number of hepatic encephalopathy episodes was significantly higher in the TIPS group (1.93 versus 0.63). Nevertheless, the cumulative probability of developing such an episode was similar between groups.

Subgroup analysis showed that age, serum bilirubin level, plasma sodium level, as well as treatment allocation were independently associated with transplant-free survival.

Thus, continued Dr. Salerno, "a careful selection of the patients suitable for TIPS is very important to replicate in the daily practice the results we obtained in our study."

The success of TIPS implantation," he concluded, "is related to the experience of the radiologist."

Gastroenterology 2007;133:825-834.