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 (DAAs).


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 ± 3.5 to 10.8 ± 3.4 and from 11.1 ± 3.5 to 10.3 ± 3.4, 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.
['Gitto|Stefano|S|', 'Vizzutti|Francesco|F|', 'Schepis|Filippo|F|', 'Turco|Laura|L|', 'Aspite|Silvia|S|', 'Vitale|Giovanni|G|', 'Arena|Umberto|U|', 'Villa|Erica|E|', 'Laffi|Giacomo|G|', 'Debernardi-Venon|Wilma|W|', 'Fanelli|Fabrizio|F|', 'Andreone|Pietro|P|', 'Marra|Fabio|F|', '|||']
D000368:Aged D000998:Antiviral Agents D016022:Case-Control Studies D058625:End Stage Liver Disease D005260:Female D006526:Hepatitis C D006801:Humans D006975:Hypertension, Portal D007558:Italy D053208:Kaplan-Meier Estimate D008103:Liver Cirrhosis D016015:Logistic Models D008297:Male D008875:Middle Aged D019168:Portasystemic Shunt, Transjugular Intrahepatic D011183:Postoperative Complications D012720:Severity of Illness Index D016896:Treatment Outcome
Portal hypertension Advanced liver disease Antiviral therapy Cirrhosis complications