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. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Gitto, Stefano; Vizzutti, Francesco; Schepis, Filippo; Turco, Laura; Aspite, Silvia; Vitale, Giovanni; Arena, Umberto; Villa, Erica; Laffi, Giacomo; Debernardi-Venon, Wilma; Fanelli, Fabrizio; Andreone, Pietro; Marra, Fabio; Apolito, Pasquale; Campani, Claudia; Sadalla, Sinan; Lombardo, Federica; Conti, Fabio; Scuteri, Alessandra
• Is Part Of: Digestive and liver disease. Volume 51:Issue 6(2019)
• Page Start: 870
• Page End: 874
• Publication Date: 2019-06
• Subjects: Advanced liver disease -- Antiviral therapy -- Cirrhosis complications -- Portal hypertension; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2018.11.015
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: 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.