Prognosis of patients undergoing salvage TIPS is still poor in the preemptive TIPS era - Sorbonne Université Access content directly
Journal Articles Clinics and Research in Hepatology and Gastroenterology Year : 2021

Prognosis of patients undergoing salvage TIPS is still poor in the preemptive TIPS era

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.
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Dates and versions

hal-04542044 , version 1 (11-04-2024)

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Charlotte Bouzbib, Philippe Cluzel, Philippe Sultanik, Brigitte Bernard-Chabert, Julien Massard, et al.. Prognosis of patients undergoing salvage TIPS is still poor in the preemptive TIPS era. Clinics and Research in Hepatology and Gastroenterology, 2021, 45 (6), pp.101593. ⟨10.1016/j.clinre.2020.101593⟩. ⟨hal-04542044⟩
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