摘要
The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be effective in the control of refractory or recidivant ascites. However, the effec t of TIPS on survival as compared with that of large-volume paracentesis plus a lbumin is uncertain. A multicenter, prospective, clinical trial was performed in 66 patients with cirrhosis and refractory or recidivant ascites (16 Child-Turc otte-Pugh class B and 50 Child-Turcotte-Pugh class C) randomly assigned to tr eatment with TIPS (n = 33) or with large-volume paracentesis plus human albumin (n = 33). The primary endpoint was survival without liver transplantation. Seco ndary endpoints were treatment failure, rehospitalization, and occurrence of com plications. Thirteen patients treated with TIPS and 20 patients treated with par acentesis died during the study period, 4 patients in each group underwent liver transplantation. The probability of survival without transplantation was 77%at 1 year and 59%at 2 years in the TIPS group as compared with 52%and 29%in the paracentesis group (P = .021). In a multivariate analysis, treatment with parac entesis and higher MELD score showed to independently predict death. Treatment f ailure was more frequent in patients assigned to paracentesis, whereas severe ep isodes of hepatic encephalopathy occurred more frequently in patients assigned t o TIPS. The number and duration of rehospitalizations were similar in the two gr oups. In conclusion, compared to large-volume paracentesis plus albumin, TIPS i mproves survival without liver transplantation in patients with refractory or re cidivant ascites.
The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be effective in the control of refractory or recidivant ascites. However, the effec t of TIPS on survival as compared with that of large-volume paracentesis plus a lbumin is uncertain. A multicenter, prospective, clinical trial was performed in 66 patients with cirrhosis and refractory or recidivant ascites (16 Child-Turc otte-Pugh class B and 50 Child-Turcotte-Pugh class C) randomly assigned to tr eatment with TIPS (n = 33) or with large-volume paracentesis plus human albumin (n = 33). The primary endpoint was survival without liver transplantation. Seco ndary endpoints were treatment failure, rehospitalization, and occurrence of com plications. Thirteen patients treated with TIPS and 20 patients treated with par acentesis died during the study period, 4 patients in each group underwent liver transplantation. The probability of survival without transplantation was 77%at 1 year and 59%at 2 years in the TIPS group as compared with 52%and 29%in the paracentesis group (P = .021). In a multivariate analysis, treatment with parac entesis and higher MELD score showed to independently predict death. Treatment f ailure was more frequent in patients assigned to paracentesis, whereas severe ep isodes of hepatic encephalopathy occurred more frequently in patients assigned t o TIPS. The number and duration of rehospitalizations were similar in the two gr oups. In conclusion, compared to large-volume paracentesis plus albumin, TIPS i mproves survival without liver transplantation in patients with refractory or re cidivant ascites.
