TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites:An updated meta-analysis

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 10; pp. 2704 - 2714
• Main Author: Bai, Ming
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 14.03.2014
• Subjects: Asci; Ascites - diagnosis; Ascites - etiology; Ascites - mortality; Ascites - surgery; Chi-Square Distribution; Disease-Free Survival; Hepatic Encephalopathy - etiology; Hepatic Encephalopathy - surgery; Hepatorenal Syndrome - etiology; Hepatorenal Syndrome - surgery; Humans; intrahepatic; Kaplan-Meier Estimate; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Liver Cirrhosis - mortality; Liver Cirrhosis - surgery; Liver Transplantation; Meta-Analysis; Odds Ratio; Paracentesis; Portasystemic Shunt, Transjugular Intrahepatic - adverse effects; Portasystemic Shunt, Transjugular Intrahepatic - mortality; portosystemic; Recurrence; Reoperation; Risk Factors; shunt; Time Factors; Transjugular; Treatment Outcome; Ascites; Survival; Transjugular intrahepatic portosystemic shunt; Paracentesis; Meta-analysis
• ISSN: 1007-9327; 2219-2840; 2219-2840
• DOI: 10.3748/wjg.v20.i10.2704

AIM:To compare the liver transplantation-free(LTF)survival rates between patients who underwent transjugular intrahepatic portosystemic shunts(TIPS)and those who underwent paracentesis by an updated meta-analysis that pools the effects of both number of deaths and time to death.METHODS:MEDLINE,EMBASE,and the Cochrane Library were searched from the inception to October2012.LTF survival,liver transplantation,liver diseaserelated death,non-liver disease-related death,recurrent ascites,hepatic encephalopathy(HE)and severe HE,and hepatorenal syndrome were assessed as outcomes.LTF survival was estimated using a HR with a95%CI.Other outcomes were estimated using OR with95%CIs.Sensitivity analyses were performed to assess the effects of potential outliers in the studies according to the risk of bias and the study characteristics.RESULTS:Six randomized controlled trials with 390patients were included.In comparison to paracentesis,TIPS significantly improved LTF survival(HR=0.61,95%CI:0.46-0.82,P<0.001).TIPS also significantly decreased liver disease-related death(OR=0.62,95%CI:0.39-0.98,P=0.04),recurrent ascites(OR=0.15,95%CI:0.09-0.24,P<0.001)and hepatorenal syndrome(OR=0.32,95%CI:0.12-0.86,P=0.02).However,TIPS increased the risk of HE(OR=2.95,95%CI:1.87-4.66,P=0.02)and severe HE(OR=2.18,95%CI:1.27-3.76,P=0.005).CONCLUSION:TIPS significantly improved the LTF survival of cirrhotic patients with refractory ascites and decreased the risk of recurrent ascites and hepatorenal syndrome with the cost of increased risk of HE compared with paracentesis.Further studies are warranted to validate the survival benefit of TIPS in clinical practice settings.