title: Improved quality of life in patients with refractory or recidivant ascites after insertion of transjugular intrahepatic portosystemic shunts.
abstract: BACKGROUND
  We have recently shown that the transjugular intrahepatic portosystemic shunt (TIPS) is more effective than paracentesis in the treatment of cirrhotic patients with severe ascites and can prolong survival in selected patients. Although an improved quality of life (QOL) has been suggested in these patients after the TIPS procedure, so far there are no data available to substantiate this assumption. Therefore, the aim of this study was to determine the effect of TIPS on the QOL in cirrhotic patients with refractory or recidivant ascites.
  
  
  METHODS
  21 cirrhotic patients who underwent TIPS for refractory or recidivant ascites were investigated. All patients were pretreated with repeated paracentesis for at least 1 year. Before the procedure and at 3 and 6 months during follow-up, the patients themselves rated QOL, fatigue and physical performance on a visual analogue scale (range 0-100). Furthermore, QOL was determined by the QOL index (range 0-10) according to Spitzer.
  
  
  RESULTS
  Patients' rating of the QOL on the visual analogue scale significantly increased from 35 +/- 25 (baseline) to 64 +/- 28 (3 months), and 66 +/- 24 (6 months; p = 0.02). Similarly, the QOL index significantly increased from 6.9 +/- 2.0 (baseline) to 8.3 +/- 2.1 (3 months), and 8.6 +/- 1.7 (6 months; p < 0.001). The increase of QOL was more pronounced in patients with complete response to TIPS.
  
  
  CONCLUSIONS
  We demonstrate that TIPS for refractory or recidivant ascites improves the QOL in patients with cirrhosis. Our data indicates that this improvement is dependent on the response to therapy.
authors.affiliation: Department of Medicine II, Klinikum of the University of Munich-Grosshadern, Germany. Viet.Guelberg@med2.med.uni-muenchen.de
authors.forename: Veit
authors.initials: V
authors.lastname: Gülberg
authors.forename: Ingrid
authors.initials: I
authors.lastname: Liss
authors.forename: Manfred
authors.initials: M
authors.lastname: Bilzer
authors.forename: Tobias
authors.initials: T
authors.lastname: Waggershauser
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Gerbes
mesh_terms: D001201:Ascites / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome