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

Abstract Background & Aims Reduction in 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 vs 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 vs 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 < .001). De‐novo incidence of HE was similar in ePTFE ‐ TIPS and LVP +A patients (log‐rank P = .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 = .033). Age (odds ratio ( OR ):1.05; 95% confidence interval (95% CI):1.03‐1.07; P < .001), serum albumin ( OR : 0.95; 95% CI: 0.92‐0.99; P = .013) and hepatocellular carcinoma ( OR : 1.66; 95% CI: 1.06‐2.58; P = .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.