Ahmad Parvinian MD, Presenter: Nothing to Disclose

Leigh Casadaban BS, Abstract Co-Author: Research Grant, Guerbet SA

Jeet Minocha MD, Abstract Co-Author: Nothing to Disclose

Martha-Gracia Knuttinen MD, PhD, Abstract Co-Author: Nothing to Disclose

James Thuan Bui MD, Abstract Co-Author: Nothing to Disclose

Charles E. Ray MD, PhD, Abstract Co-Author: Nothing to Disclose

Ron Charles Gaba MD, Abstract Co-Author: Nothing to Disclose

Ascites is a leading cause of morbidity and mortality among cirrhotic patients: it occurs in 50% within 10 years of diagnosis and becomes medically refractory in 5-10%, which entails a 1-year mortality rate of up to 50%. Transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective treatment for ascites secondary to portal hypertension. While the benefits of this procedure are well documented, data regarding the effect of TIPS on survival remain unproven. To that end, this study aims to quantify the impact of TIPS creation on survival in the setting of ascites. 

In this single-institution retrospective study, 79 patients who underwent TIPS for refractory ascites from 2001-2014 were compared with a cohort of 80 patients with refractory or recidivant ascites due to decompensated liver disease who underwent serial paracentesis procedures during the same time period. Data pertaining to demographic and liver disease characteristics, Model for End Stage Liver Disease (MELD) scores, and survival outcomes were obtained from electronic medical record review and the social security death index. Survival outcomes were analyzed using Kaplan-Meier statistics with log-rank comparison. 

The TIPS cohort comprised 56 men and 23 women (mean age 54 years, mean MELD 15); the no-TIPS cohort comprised 46 men and 34 women (mean age 54 years, mean MELD 22.5). Survival was enhanced with TIPS: median survival was 1100±371 days in the TIPS cohort and 262±121 days in the no-TIPS cohort (P=0.021). Median survival among patients with MELD scores ≤18 was 1219±436 days versus 262±77 days (P=0.01) in the TIPS versus no-TIPS cohorts, respectively. Survival was similar in patients with MELD >18 (130± 602 versus 322± 220 days, P=.829). There was no significant difference in mortality between the TIPS and no-TIPS groups at 30 days (13.2% versus 12.5%, P=1.0) or 90 days (21.1% versus 28.8% P=0.58), indicating short-term procedure safety.

TIPS creation enhances long-term survival without significantly impacting short-term mortality in patients with ascites. 

TIPS imparts a quantifiable survival benefit on patients with ascites. A precise understanding of this benefit may aid in temporal optimization of TIPS allocation as a bridge to definitive therapy.   

Parvinian, A, Casadaban, L, Minocha, J, Knuttinen, M, Bui, J, Ray, C, Gaba, R, Survival Benefit of TIPS in Patients with Refractory Ascites: A Single Institution Case-Control Analysis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14019485.html