title: Survival benefit of TIPS versus serial paracentesis in patients with refractory ascites: a single institution case-control propensity score analysis.
abstract: OBJECTIVE
  To compare the impact of covered stent-graft transjugular intrahepatic portosystemic shunt (TIPS) versus serial paracentesis on survival of patients with medically refractory ascites.
  
  
  METHODS
  In this retrospective study, cirrhotic patients who underwent covered stent-graft TIPS for refractory ascites from 2003-2013 were compared with similar patients who underwent serial paracentesis during 2009-2013. Demographic and liver disease data, Model for End-Stage Liver Disease (MELD) scores, and survival outcomes were obtained from hospital electronic medical records and the social security death index. After propensity score weighting to match study group characteristics, survival outcomes were compared using Kaplan-Meier statistics with log-rank analysis.
  
  
  RESULTS
  Seventy TIPS (70% men, mean age 55.7 years, mean MELD 15.1) and 80 paracentesis (58% men, mean age 53.5 years, mean MELD 22.5) patients were compared. The TIPS haemodynamic success rate was 100% (mean portosystemic pressure gradient reduction 13 mmHg). Paracentesis patients underwent a mean of 7.9 procedures. After propensity score weighting to balance group features, TIPS patients showed a trend toward enhanced survival compared with paracentesis patients (median survival 1037 versus 262 days, p = 0.074). TIPS conferred a significant increase or trend toward improved survival compared with paracentesis at 1 (66% versus 44%, p = 0.018), 2 (56% versus 38%, p = 0.057), and 3 year (49% versus 32%, p = 0.077) time points. Thirty and 90 day mortality rates were not statistically increased by TIPS.
  
  
  CONCLUSIONS
  Covered stent-graft TIPS improves intermediate- to long-term survival without significantly increasing short-term mortality of ascites patients, and suggests a greater potential role for TIPS in properly selected ascitic patients when medical management fails.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, USA. Electronic address: rgaba@uic.edu.
authors.forename: R C
authors.initials: RC
authors.lastname: Gaba
authors.affiliation: University of Illinois College of Medicine, University of Illinois Hospital and Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612, USA.
authors.forename: A
authors.initials: A
authors.lastname: Parvinian
authors.affiliation: University of Illinois College of Medicine, University of Illinois Hospital and Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Casadaban
authors.affiliation: University of Illinois College of Medicine, University of Illinois Hospital and Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Couture
authors.affiliation: Department of Radiology, Division of Interventional Radiology, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Zivin
authors.affiliation: University of Illinois College of Medicine, University of Illinois Hospital and Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lakhoo
authors.affiliation: Department of Radiology, Division of Interventional Radiology, USA.
authors.forename: J
authors.initials: J
authors.lastname: Minocha
authors.affiliation: Department of Radiology, Division of Interventional Radiology, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Ray
authors.affiliation: Department of Radiology, Division of Interventional Radiology, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Knuttinen
authors.affiliation: Department of Radiology, Division of Interventional Radiology, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Bui
mesh_terms: D001201:Ascites / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods*; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler