Prognosis of patients undergoing salvage TIPS is still poor in the preemptive TIPS era - 11/11/21
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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.
Il testo completo di questo articolo è disponibile in 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
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Vol 45 - N° 6
Articolo 101593- Novembre 2021 Ritorno al numero
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