title: TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: an updated meta-analysis.
abstract: OBJECTIVE
  To compare the liver transplantation-free (LTF) survival rates between patients who underwent transjugular intrahepatic portosystemic shunts (TIPS) and those who underwent paracentesis by an updated meta-analysis that pools the effects of both number of deaths and time to death.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Library were searched from the inception to October 2012. LTF survival, liver transplantation, liver disease-related death, non-liver disease-related death, recurrent ascites, hepatic encephalopathy (HE) and severe HE, and hepatorenal syndrome were assessed as outcomes. LTF survival was estimated using a HR with a 95%CI. Other outcomes were estimated using OR with 95%CIs. Sensitivity analyses were performed to assess the effects of potential outliers in the studies according to the risk of bias and the study characteristics.
  
  
  RESULTS
  Six randomized controlled trials with 390 patients were included. In comparison to paracentesis, TIPS significantly improved LTF survival (HR = 0.61, 95%CI: 0.46-0.82, P < 0.001). TIPS also significantly decreased liver disease-related death (OR = 0.62, 95%CI: 0.39-0.98, P = 0.04), recurrent ascites (OR = 0.15, 95%CI: 0.09-0.24, P < 0.001) and hepatorenal syndrome (OR = 0.32, 95%CI: 0.12-0.86, P = 0.02). However, TIPS increased the risk of HE (OR = 2.95, 95%CI: 1.87-4.66, P = 0.02) and severe HE (OR = 2.18, 95%CI: 1.27-3.76, P = 0.005).
  
  
  CONCLUSIONS
  TIPS significantly improved the LTF survival of cirrhotic patients with refractory ascites and decreased the risk of recurrent ascites and hepatorenal syndrome with the cost of increased risk of HE compared with paracentesis. Further studies are warranted to validate the survival benefit of TIPS in clinical practice settings.
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Man Yang, Dai-Ming Fan, Department of Digestive Interventional Radiology; State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shannxi Province, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Bai
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Man Yang, Dai-Ming Fan, Department of Digestive Interventional Radiology; State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shannxi Province, China.
authors.forename: Xing-Shun
authors.initials: XS
authors.lastname: Qi
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Man Yang, Dai-Ming Fan, Department of Digestive Interventional Radiology; State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shannxi Province, China.
authors.forename: Zhi-Ping
authors.initials: ZP
authors.lastname: Yang
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Man Yang, Dai-Ming Fan, Department of Digestive Interventional Radiology; State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shannxi Province, China.
authors.forename: Man
authors.initials: M
authors.lastname: Yang
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Man Yang, Dai-Ming Fan, Department of Digestive Interventional Radiology; State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shannxi Province, China.
authors.forename: Dai-Ming
authors.initials: DM
authors.lastname: Fan
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Man Yang, Dai-Ming Fan, Department of Digestive Interventional Radiology; State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shannxi Province, China.
authors.forename: Guo-Hong
authors.initials: GH
authors.lastname: Han
mesh_terms: D001201:Ascites / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000601:surgery; D006530:Hepatorenal Syndrome / Q000209:etiology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D016017:Odds Ratio; D019152:Paracentesis; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ascites; Meta-analysis; Paracentesis; Survival; Transjugular intrahepatic portosystemic shunt