ePTFE-TIPS vs repetitive LVP plus albumin for the treatment of refractory ascites in patients with cirrhosis

Introduction Reduction of portal pressure by self-expandable polytetrafluoroethylene (ePTFE)-covered transjugular intrahepatic portosystemic shunts (TIPS) is a treatment option for refractory ascites. Data on clinical outcomes after ePTFE-TIPS versus repetitive large-volume paracentesis (LVP) plus albumin (A) administration for the treatment of patients with refractory ascites are limited. Methods Retrospective comparison of ePTFE-TIPS versus LVP+A in terms of (i) control of ascites, (ii) occurrence of overt hepatic encephalopathy (HE) and (iii) transplant-free survival in cirrhotic patients with refractory ascites. Results Among n=221 patients with cirrhosis and refractory ascites, n=140 received ePTFE-TIPS and were compared to n=71 patients undergoing repetitive LVP+A. After ePTFE-TIPS, ascites was controlled without any further need for paracentesis in n=76 (54%; n=7 without and n=69 with diuretics). The need for frequent large-volume paracentesis was significantly higher in the LVP+A group than with ePTFE-TIPS (median 0.67 (IQR 0.23-2.63) months vs. 49.5 (IQR 5.07-102.60) months until paracentesis, log-rank p<0.001). De-novo incidence of HE was similar in ePTFE-TIPS and LVP+A patients (log-rank p=0.361). Implantation of ePTFE-TIPS was associated with improved 1-year survival as compared to LVP+A (65.6% vs. 48.4%, log-rank p=0.033). Age (odds ratio (OR):1.05; 95% confidence interval (95%CI):1.03-1.07;p<0.001), serum albumin (OR:0.95; 95%CI:0.92-0.99;p=0.013) and hepatocellular carcinoma (OR:1.66; 95%CI:1.06-2.58;p=0.026) emerged as independent predictors of survival. Conclusions ePTFE-TIPS results in superior control of ascites without increasing the risk for overt HE as compared to LVP+A. Although ePTFE-TIPS improved 1-year survival in cirrhotic patients with refractory ascites, its use was not independently associated with transplant-free survival. This article is protected by copyright. All rights reserved.