Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis.
OBJECTIVE
The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be more effective than repeated paracentesis plus albumin in the control of refractory ascites. However, its effect on survival and healthcare costs is still uncertain.


METHODS
Seventy patients with cirrhosis and refractory ascites were randomly assigned to TIPS (35 patients) or repeated paracentesis plus intravenous albumin (35 patients). The primary endpoint was survival without liver transplantation. Secondary endpoints were complications of cirrhosis and costs.


RESULTS
Twenty patients treated with TIPS and 18 treated with paracentesis died during the study period, whereas 7 patients in each group underwent liver transplantation (mean follow-up 282 +/- 43 vs. 325 +/- 61 days, respectively). The probability of survival without liver transplantation was 41% at 1 year and 26% at 2 years in the TIPS group, as compared with 35% and 30% in the paracentesis group (P = 0.51). In a multivariate analysis, only baseline blood urea nitrogen levels and Child-Pugh score were independently associated with survival. Recurrence of ascites and development of hepatorenal syndrome were lower in the TIPS group compared with the paracentesis group, whereas the frequency of severe hepatic encephalopathy was greater in the TIPS group. The calculated costs were higher in the TIPS group than in the paracentesis group.


CONCLUSIONS
In patients with refractory ascites, TIPS lowers the rate of ascites recurrence and the risk of developing hepatorenal syndrome. However, TIPS does not improve survival and is associated with an increased frequency of severe encephalopathy and higher costs compared with repeated paracentesis plus albumin.
Ginès
Pere
P
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), University of Barcelona, Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
Uriz
Juan
J
Calahorra
Blas
B
Garcia-Tsao
Guadalupe
G
Kamath
Patrick S
PS
Del Arbol
Luis Ruiz
LR
Planas
Ramón
R
Bosch
Jaime
J
Arroyo
Vicente
V
Rodés
Juan
J
D001201:Ascites / Q000209:etiology*; D001424:Bacterial Infections; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006501:Hepatic Encephalopathy / Q000503:physiopathology; D006728:Hormones / Q000097:blood; D006801:Humans; D007275:Injections, Intravenous; D007668:Kidney / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D010538:Peritonitis / Q000150:complications / Q000382:microbiology; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D019233:Retreatment; D012709:Serum Albumin / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016019:Survival Analysis
D006728:Hormones; D012709:Serum Albumin