Covered transjugular intrahepatic portosystemic stent-shunt vs large volume paracentesis in patients with cirrhosis: A real-world propensity score-matched study  

作　　者：Amritpal Dhaliwal Homoyoon Merhzad Salil Karkhanis Dhiraj Tripathi 

机构地区：[1]Department of Hepatology,Queen Elizabeth Hospital Birmingham,Birmingham B152TT,United Kingdom [2]National Institute of Health and Care Research,Biomedical Research Centre Birmingham,University of Birmingham,Birmingham B152WB,United [3]Department of Radiology,Queen Elizabeth Hospital Birmingham,Birmingham B152TT,United Kingdom

出　　处：《World Journal of Clinical Cases》2022年第31期11313-11324,共12页世界临床病例杂志

摘　　要：BACKGROUND Refractory ascites has a 1-year survival rate of 50%.In selected patients,treatment options include liver transplantation(LT)or transjugular intrahepatic portosystemic stent shunt(TIPSS).AIM To assess the outcomes of patients who underwent a TIPSS compared to large volume paracentesis(LVP).METHODS Retrospective study of patients who underwent a covered TIPSS or LVP for refractory or recurrent ascites over 7 years.Primary outcome was transplant-free survival(TFS).Further analysis was done with propensity score matching(PSM).RESULTS There were 150 patients[TIPSS group(n=75),LVP group(n=75)].Seven patients in the TIPSS group underwent LT vs 22 patients in the LVP group.Overall median follow up,20(0.47-179.53)mo.In the whole cohort,there was no difference in TFS[hazard ratio(HR):0.80,95%confidence interval(CI):0.54-1.21];but lower de novo hepatic encephalopathy with LVP(HR:95%CI:0.20-0.96).These findings were confirmed following PSM analysis.On multivariate analysis albumin and hepatocellular carcinoma at baseline were associated with TFS.CONCLUSION Covered TIPSS results in similar TFS compared to LVP in cirrhotic patients with advanced liver failure.Liver transplant assessment should be considered in all potential candidates for TIPSS.Further controlled studies are recommended to select appropriate patients for TIPSS.

关 键 词：Portal hypertension Liver cirrhosis Transjugular intrahepatic portosystemic shunt ASCITES Large volume paracentesis 

分 类 号：R575.2[医药卫生—消化系统]