Meta-Analysis
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World J Gastroenterol. Mar 14, 2014; 20(10): 2704-2714
Published online Mar 14, 2014. doi: 10.3748/wjg.v20.i10.2704
TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: An updated meta-analysis
Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Man Yang, Dai-Ming Fan, Guo-Hong Han
Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Man Yang, Dai-Ming Fan, Department of Digestive Interventional Radiology; State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an 710032, Shannxi Province, China
Guo-Hong Han, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an 710032, Shannxi Province, China
Author contributions: Bai M, Han GH and Fan DM designed the research and wrote the paper; Bai M, Qi XS, Yang ZP and Yang M performed the study; Bai M, Qi XS and Yang ZP analyzed the data.
Correspondence to: Guo-Hong Han, MD, Professor, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.127 West Changle Road, Xi’an 710032, Shannxi Province, China. hangh2009@gmail.com
Telephone: +86-29-84771522 Fax: +82-29-82539041
Received: July 4, 2013
Revised: October 8, 2013
Accepted: November 2, 2013
Published online: March 14, 2014
Processing time: 252 Days and 3.3 Hours
Abstract

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 October 2012. LTF survival, liver transplantation, liver disease-related 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 a 95%CI. Other outcomes were estimated using OR with 95%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 390 patients 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.

Keywords: Transjugular intrahepatic portosystemic shunt; Ascites; Paracentesis; Survival; Meta-analysis

Core tip: We evaluated the effects of transjugular intrahepatic portosystemic shunts (TIPS) vs paracentesis on the liver transplantation-free (LTF) survival in patients with cirrhosis and refractory ascites. Both the number of deaths and the time to death were considered in the present meta-analysis. We found that TIPS significantly improved LTF survival, liver disease-related death, recurrence of ascites, and hepatorenal syndrome; however, TIPS increased the risk of post-TIPS hepatic encephalopathy.