Minimal residual ascites 3 months after TIPS implantation implicates worse clinical outcomes in patients with cirrhosis

作者：Jim Benjamin Mauz, Lukas Hartl, Andrea Kornfehl, Sarah Lisa Schütte, Paul Hemetsberger, Theresa Bucsics, Mathias Jachs, Anja Tiede, Hannah Rieland, Michael Schwarz, Nina Dominik, Georg Kramer, Bernhard Meyer, Lukas Reider, Michael Trauner, Heiner Wedemeyer, Mattias Mandorfer, Benjamin Maasoumy, Thomas Reiberger, Tammo Lambert Tergast · 发表于：JHEP Reports · 年份：2025 · DOI：10.1016/j.jhepr.2025.101335 · 被引用次数：3 · 研究领域：Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes、Liver Disease Diagnosis and Treatment

Background & Aims Transjugular intrahepatic portosystemic shunt (TIPS) implantation is indicated for recurrent/refractory ascites in patients with cirrhosis. The prognostic impact of residual minimal ascites after TIPS implantation has not yet been investigated. Methods We included patients with cirrhosis undergoing covered TIPS implantation for refractory ascites in Vienna (2000–2022) and Hannover (2009–2021) with available abdominal ultrasound 3 months after TIPS insertion (3M). The patients were followed up for further decompensation and transplant-free mortality. Two distinct competing risk regression models (Adjusted model I and Adjusted model II) were performed to determine the prognostic impact of no vs. minimal ascites at 3M. Results Overall, 292 patients with male predominance (71.7%) and mostly alcohol-related liver disease (71.7%) were included. At 3M, n=105 (36.0%) patients showed no ascites on abdominal ultrasound, whereas n=82 (28.1%) exhibited minimal and n=105 (36.0%) moderate/severe ascites. The portal pressure gradient after TIPS implantation was similar in the three groups (median 7 mmHg; p = 0.311). Patients with no or minimal ascites had comparable Model for End-Stage Liver Disease and Freiburg Index of Post-TIPS Survival scores at baseline and 3M. Competing risk regression models showed that minimal ascites ( vs. no ascites) was an independent predictor of further decompensation (Adjusted model I: adjusted subdistribution hazard ratio [aSHR], 1.69; 95% C...