Transjugular Intrahepatic Portosystemic Shunt does not affect the efficacy and safety of direct-acting antivirals in patients with advanced cirrhosis: A real-life, case-control study

Background: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a well-established treatment for complications of portal hypertension. Aims: To analyze the impact of TIPS on virologic response and safety profile in patients treated with direct-acting antivirals (DAA). Methods: We analyzed data from HCV-positive cirrhotic patients treated with DAAs. Twenty-one patients with previous TIPS placement were compared with 42 matched subjects without TIPS. Logistic regression was used to identify predictors of hepatic function worsening and adverse events. Results: No differences were found between the two groups in particular regarding sustained virologic response (92.5 and 97.6% in TIPS vs no-TIPS, p=0.559). Model for End-stage Liver Disease (MELD) of both TIPS and no-TIPS groups declined from baseline to week 24 of follow-up (from 12.5\ub13.5 to 10.8\ub13.4 and from 11.1\ub13.5 to 10.3\ub13.4, p=0.044 and 0.025). There were no differences in adverse event rates. At univariate analysis, age was associated with MELD increase from baseline to week 24 (OR 1.111, 95% CI 1.019-1.211, p=0.017), and patients with higher baseline MELD developed serious adverse events more frequently (OR 0.815, 95% CI 0.658-1.010, p=0.062). Patients with or without TIPS did not show differences in transplant-free survival. Conclusion: TIPS placement does not affect virologic response and clinical outcome of patients receiving DAAs

Mortality after transjugular intrahepatic portosystemic shunt in older adult cirrhotic patients: a validated prediction model

none34Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) improves survival in cirrhotic patients with refractory ascites and portal hypertensive bleeding. However, the indication for TIPS in older adult patients (≥70 years) is debated and a specific prediction model developed in this particular setting is lacking. The aim of this study was to develop and validate a multivariable model for an accurate prediction of mortality in older adults.Vizzutti, Francesco; Celsa, Ciro; Calvaruso, Vincenza; Enea, Marco; Battaglia, Salvatore; Turco, Laura; Senzolo, Marco; Nardelli, Silvia; Miraglia, Roberto; Roccarina, Davide; Campani, Claudia; Saltini, Dario; Caporali, Cristian; Indulti, Federica; Gitto, Stefano; Zanetto, Alberto; Di Maria, Gabriele; Bianchini, Marcello; Pecchini, Maddalena; Aspite, Silvia; Di Bonaventura, Chiara; Citone, Michele; Guasconi, Tomas; Di Benedetto, Fabrizio; Arena, Umberto; Fanelli, Fabrizio; Maruzzelli, Luigi; Riggio, Oliviero; Burra, Patrizia; Colecchia, Antonio; Villa, Erica; Marra, Fabio; Cammà, Calogero; Schepis, FilippoVizzutti, Francesco; Celsa, Ciro; Calvaruso, Vincenza; Enea, Marco; Battaglia, Salvatore; Turco, Laura; Senzolo, Marco; Nardelli, Silvia; Miraglia, Roberto; Roccarina, Davide; Campani, Claudia; Saltini, Dario; Caporali, Cristian; Indulti, Federica; Gitto, Stefano; Zanetto, Alberto; Di Maria, Gabriele; Bianchini, Marcello; Pecchini, Maddalena; Aspite, Silvia; Di Bonaventura, Chiara; Citone, Michele; Guasconi, Tomas; Di Benedetto, Fabrizio; Arena, Umberto; Fanelli, Fabrizio; Maruzzelli, Luigi; Riggio, Oliviero; Burra, Patrizia; Colecchia, Antonio; Villa, Erica; Marra, Fabio; Cammà, Calogero; Schepis, Filipp