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Patient Selection in Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Refractory Ascites and Associated Conditions

  • Portal Hypertension (J Gonzalez-Abraldes and E Tsochatzis, Section Editors)
  • Published:
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Abstract

Purpose of Review

This review summarizes the key developments and latest evidence for transjugular intrahepatic portosystemic shunt (TIPS) for the indications of refractory ascites and related conditions, as well as factors that should be taken into consideration with regard to patient selection.

Recent Findings

Recent evidence from randomized controlled studies has suggested that the early institution of TIPS in well-selected patients with refractory ascites may confer a survival benefit. Increasing evidence is also mounting on the potential role of TIPS in improving and reversing hepatorenal syndrome.

Summary

TIPS has conventionally been sought as a second-line treatment for refractory ascites. Recent evidence has suggested a potential survival benefit with early TIPS in well-compensated patients for this indication; this may lead to a paradigm shift for TIPS to be considered as primary therapy in well-selected “low-risk” patients. In hepatorenal syndrome, while evidence on TIPS is limited, multiple studies have shown a serendipitous improvement to renal function in both type 1 and 2 hepatorenal syndrome following TIPS.

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Abbreviations

AASLD:

American Association for the Study of Liver

AKI-HRS:

Acute kidney injury–hepatorenal syndrome

CP:

Childs-Pugh

CKD-HRS:

Chronic kidney disease–hepatorenal syndrome

HE:

Hepatic encephalopathy

HRS:

Hepato-renal syndrome

LVP:

Large-volume paracentesis

MELD:

Model for end-stage liver disease

RCT:

Randomized controlled trial

TIPS:

Transjugular intrahepatic portosystemic shunt

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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  1. Division of Gastroenterology (Liver Unit), University of Alberta Hospital, 1-40 Zeidler Ledcor Building, Edmonton, Alberta, T6G-2X8, Canada

    Beverley Kok & Juan Gonzalez Abraldes

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Juan Gonzalez-Abraldes reports lecture fees from GILEAD, Ferring, and Lupin, as well as consulting from GILEAD, Pfizer, and Theravance outside the submitted work. Beverley Kok declares no potential conflicts of interest.

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Kok, B., Abraldes, J.G. Patient Selection in Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Refractory Ascites and Associated Conditions. Curr Hepatology Rep 18, 197–205 (2019). https://doi.org/10.1007/s11901-019-00470-4

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