Benefits of TIPS for Patients With Large Ascites Preceding Recurrent or Refractory ascites: A Multicenter Cohort Study

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology Pub Date : 2025-03-26 DOI:10.1111/jgh.16948

Yifu Xia, Jun Tie, Guangchuan Wang, Hao Wu, Yuzheng Zhuge, Xulong Yuan, Guangjun Huang, Zhen Li, Xu Liu, Anbang Chen, Linhao Zhang, Zihao Cai, Chengwei Tang, Chunqing Zhang

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引用次数: 0

Abstract

Background and Aim

Patients with recurrent or refractory ascites can benefit from transjugular intrahepatic portosystemic shunt (TIPS). However, the value of TIPS for patients with large ascites remains unclear.

Methods

This retrospective multicenter study included patients who underwent TIPS or medicine plus large-volume paracentesis (medicine + LVP) for ascites between January 2014 and December 2022 at five centers. The primary endpoint was recurrence or worsening of ascites. The secondary endpoints were liver-related death, all-cause hemorrhage, overt hepatic encephalopathy (OHE), and shunt dysfunction.

Results

Overall, 724 patients were evaluated, including 373 patients with large ascites preceding recurrent or refractory ascites received TIPS (the LA-TIPS group), 282 patients with recurrent and refractory ascites received TIPS (the RA-TIPS group), and 69 patients with large ascites preceding recurrent or refractory ascites received medicine + LVP (the LA-M group). Patients in the LA-TIPS group had significantly lower incidences of recurrence or worsening of ascites (37.4% vs. 45.3%, p < 0.001), liver-related death (44.8% vs. 62.0%, p < 0.001), and OHE (47.3% vs. 60.3%, p < 0.001) than those in the RA-TIPS group. Meanwhile, patients in the LA-TIPS group had significantly lower incidences of recurrence or worsening of ascites (37.4% vs. 44.6%, p = 0.006) and hemorrhage (38.3% vs. 47.2%, p = 0.042), but a higher incidence of OHE (34.2% vs. 4.5%, p < 0.001) than those in the LA-M group.

Conclusions

In terms of controlling ascites, the benefit of TIPS was greater in patients with large ascites preceding recurrent or refractory ascites, suggesting that TIPS might be considered in patients with large ascites before they progress to recurrent or refractory stages.

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TIPS对腹水复发或难治性腹水患者的益处：一项多中心队列研究

背景和目的：复发性或难治性腹水患者可以从经颈静脉肝内门静脉系统分流术（TIPS）中获益。然而，TIPS对大量腹水患者的价值尚不清楚。方法：这项回顾性多中心研究纳入了2014年1月至2022年12月在五个中心接受TIPS或药物加大容量穿刺（药物+ LVP）治疗腹水的患者。主要终点为腹水复发或恶化。次要终点是肝脏相关死亡、全因出血、显性肝性脑病（OHE）和分流功能障碍。结果：总共评估了724例患者，其中373例大腹水前复发或难治性腹水患者接受TIPS （LA-TIPS组），282例复发和难治性腹水患者接受TIPS （RA-TIPS组），69例大腹水前复发或难治性腹水患者接受药物+ LVP （LA-M组）。LA-TIPS组患者腹水复发或恶化的发生率显著降低（37.4% vs. 45.3%） p结论：在控制腹水方面，TIPS对复发或难治性腹水前的大腹水患者的益处更大，提示在大腹水进展到复发或难治性阶段之前可考虑TIPS。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.40%

发文量

326

审稿时长

2.3 months

期刊介绍： Journal of Gastroenterology and Hepatology is produced 12 times per year and publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatology, gastroenterology and endoscopy. Papers cover the medical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas. All submitted papers are reviewed by at least two referees expert in the field of the submitted paper.