肝硬変および再発性腹水の患者におけるTIPSの生存率改善：多施設共同観察研究

Currently, there is limited evidence regarding the survival benefit of transjugular intrahepatic portal shunt (TIPS) placement in patients with advanced cirrhosis and recurrent ascites. This study aimed to assess whether TIPS improves the survival in such population compared with large volume paracenteses plus albumin (LVP + A).

This retrospective study included 462 patients with advanced cirrhosis and recurrent ascites who were treated with TIPS (N = 151) or LVP + A (N = 311) at 11 tertiary hospitals in China between September 2014 and September 2020. The Fine and Gray competing risk regression model was used to compare the outcomes between the two groups after adjusting for liver disease severity and other potential confounders.

1-year overall survival was significantly higher in the TIPS group than in the LVP + A group (77.9% vs 47.3%; P < 0.001), with the relative risk of mortality reduced by 57% (adjusted HR = 0.43, 95% CI: 0.29 to 0.64; P < 0.001). Furthermore, TIPS group had a lower rate of further paracentesis (17.9% vs 100%; P < 0.001) and portal hypertension-related bleeding (5.8% vs 28.1%; P < 0.001) but a higher rate of overt hepatic encephalopathy (26.5% vs 6.4%; P < 0.001) compared with LVP + A group.

In patients with advanced cirrhosis and recurrent ascites, TIPS improved the 1-year survival rates compared with LVP + A. Although TIPS increases the risk of overt hepatic encephalopathy, it can significantly decrease ascites recurrence and portal hypertension-related bleeding.