Prognosis of patients undergoing salvage TIPS is still poor in the preemptive TIPS era - 11/11/21
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| pages | 12 |
| Iconographies | 3 |
| Vidéos | 0 |
| Autres | 0 |
Highlights |
• | Survival after salvage TIPS is still poor despite the preemptive TIPS policy and the use of PTFE-covered stents. |
• | Prophylaxis of variceal bleeding, including the use of preemptive TIPS, is not well-conducted in real life. |
• | Transplant-free survival is significantly lower in patients with an inadequate secondary prophylaxis. |
Abstract |
Background |
Salvage transjugular intrahepatic portosystemic shunts (TIPS) are associated with poor prognosis, especially in patients with Child-Pugh C cirrhosis. Since preemptive TIPS improved prophylaxis of variceal bleeding in those patients, recourse to salvage TIPS may now affect patients with a better prognosis.
Aim |
To assess the impact of the preemptive TIPS policy on outcomes after salvage TIPS placement.
Methods |
We conducted a retrospective monocentric study on cirrhotic patients undergoing salvage TIPS with polytetrafluoroethylene-covered stents from 2002 to 2017 (period 1 until February 2011; period 2 after the preemptive TIPS policy in March 2011). The primary endpoint was one-year transplant-free survival.
Results |
We included 106 patients (period 1/2 = 53/53 patients, male gender 82%, age 54 ± 9 years, alcoholic cirrhosis 70%, Child-Pugh score B/C 94%). One-year transplant-free survival was 46.0% during period 1 compared to 40.2% during period 2 (p = 0.65). Amongst 61 patients with history of variceal bleeding, 32 (52.5%) had an inadequate secondary prophylaxis, including 19 (59.4%) with a previous indication of preemptive TIPS. One-year transplant-free survival was 33.2% if inadequate secondary prophylaxis vs 65.2% if adequate (p = 0.008). Independent factors associated with survival were a lower Child-Pugh or MELD score, infection, failure to control bleeding, and hepatic encephalopathy after TIPS.
Conclusion |
Prognosis after salvage TIPS remained poor in our series. Optimizing secondary prophylaxis, including preemptive TIPS placement, should be the main concern to improve prognosis.
Le texte complet de cet article est disponible en PDF.Keywords : Cirrhosis, Portal hypertension, Refractory variceal bleeding, TIPS, Prophylaxis, Child-Pugh score
Abbreviations : ALT, AST, AVB, DBP, GGT, HE, INR, IU, MELD, NASH, NSBB, PT, PTFE, SBP, TIPS, UGB
Plan
Vol 45 - N° 6
Article 101593- novembre 2021 Retour au numéro
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