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

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,EMBAS...

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Published in:World journal of gastroenterology : WJG 2014-03, Vol.20 (10), p.2704-2714
Main Authors: Bai, Ming, Qi, Xing-Shun, Yang, Zhi-Ping, Yang, Man, Fan, Dai-Ming, Han, Guo-Hong
Format: Article
Language:English
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
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Summary: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.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v20.i10.2704