Comparison of clinical outcomes in patients with refractory ascites treated with either TIPS, tunneled peritoneal catheter, or ascites pump

作者：Sarah Lisa Schütte, Anja Tiede, Jim Benjamin Mauz, Hannah Rieland, Martin Kabelitz, Robin Iker, Nicolas Richter, Bernhard Meyer, Benjamin Heidrich, Heiner Wedemeyer, Benjamin Maasoumy, Tammo Lambert Tergast · 发表于：Hepatology Communications · 年份：2025 · DOI：10.1097/hc9.0000000000000620 · 被引用次数：5 · 研究领域：Liver Disease and Transplantation、Viral gastroenteritis research and epidemiology、Lymphatic Disorders and Treatments

BACKGROUND: Refractory ascites (RA) remains a serious complication in patients with cirrhosis. Currently, the insertion of a TIPS is considered the standard of care in these patients. To achieve symptom control in those with TIPS contraindications, tunneled peritoneal catheters (PeCa) or ascites pumps were introduced. However, data comparing the available treatment options are scarce. This study aims to compare outcomes among patients with RA treated either with TIPS, PeCa, or ascites pump. METHODS: All patients with RA and cirrhosis treated at Hannover Medical School between 2009 and 2023 were evaluated. Endpoints included mortality, acute kidney injury (AKI), hyponatremia, peritonitis, and rehospitalization rate. Propensity score matching was conducted to adjust for group differences. RESULTS: First, 31 patients with ascites pump were compared to 62 patients with a PeCa after propensity score matching. There were no differences regarding mortality nor incidences of AKI, hyponatremia, or rehospitalization. However, incidences of peritonitis and explantation were lower in those with ascites pump (HR 0.32, 95% CI: 0.15-0.70, and HR 0.32, 95% CI: 0.14-0.71, respectively). Second, 35 ascites pump patients were matched with 70 individuals with TIPS. No differences regarding mortality or peritonitis incidence were observed. Ascites pump patients showed higher incidences of AKI (HR 4.55, 95% CI: 2.53-8.18) and hyponatremia (HR 4.13, 95% CI: 2.08-8.22). Last, 129 patients with TIPS ...