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

• Published in: Digestive and liver disease 2019-06, Vol.51 (6), p.870-874
• Main 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
• Format: Article
• Language: English
• Subjects: Advanced liver disease; Aged; Antiviral Agents - therapeutic use; Antiviral therapy; Case-Control Studies; Cirrhosis complications; End Stage Liver Disease - epidemiology; Female; Hepatitis C - complications; Hepatitis C - drug therapy; Humans; Hypertension, Portal - surgery; Italy; Kaplan-Meier Estimate; Liver Cirrhosis - complications; Liver Cirrhosis - virology; Logistic Models; Male; Middle Aged; Portal hypertension; Portasystemic Shunt, Transjugular Intrahepatic; Postoperative Complications - epidemiology; Severity of Illness Index; Treatment Outcome
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2018.11.015

Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a well-established treatment for complications of portal hypertension. To analyze the impact of TIPS on virologic response and safety profile in patients treated with direct-acting antivirals (DAAs). 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. 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. TIPS placement does not affect virologic response and clinical outcome of patients receiving DAAs.