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Multicenter Study
. 2022 Jun;16(3):658-668.
doi: 10.1007/s12072-022-10330-x. Epub 2022 Apr 5.

Aspirin improves transplant-free survival after TIPS implantation in patients with refractory ascites: a retrospective multicentre cohort study

Leon Louis Seifert  1 , Philipp Schindler  2 , Lukas Sturm  3 , Wenyi Gu  4 , Quentin Edward Seifert  5 , Jan Frederic Weller  6 , Christian Jansen  7 , Michael Praktiknjo  7 , Carsten Meyer  8 , Martin Schoster  9 , Christian Wilms  9 , Miriam Maschmeier  9 , Hartmut H Schmidt  9 , Max Masthoff  2 , Michael Köhler  2 , Michael Schultheiss  3 , Jan Patrick Huber  3 , Dominik Bettinger  3 , Jonel Trebicka  4 , Moritz Wildgruber  2   10 , Hauke Heinzow  9   11
Affiliations
Multicenter Study

Aspirin improves transplant-free survival after TIPS implantation in patients with refractory ascites: a retrospective multicentre cohort study

Leon Louis Seifert et al. Hepatol Int. 2022 Jun.

Abstract

Background and aims: Transjugular intrahepatic portosystemic shunt (TIPS) implantation is an established procedure to treat portal hypertension. Impact of administration of aspirin on transplant-free survival after TIPS remains unknown.

Methods: A multicenter retrospective analysis including patients with TIPS implantation between 2011 and 2018 at three tertiary German Liver Centers was performed. N = 583 patients were included. Survival analysis was performed in a matched cohort after propensity score matching. Patients were grouped according to whether aspirin was (PSM-aspirin-cohort) or was not (PSM-no-aspirin-cohort) administered after TIPS. Primary endpoint of the study was transplant-free survival at 12 months after TIPS.

Results: Aspirin improved transplant-free survival 12 months after TIPS with 90.7% transplant-free survival compared to 80.0% (p = 0.001) after PSM. Separated by TIPS indication, aspirin did improve transplant-free survival in patients with refractory ascites significantly (89.6% vs. 70.6% transplant-free survival, p < 0.001), while no significant effect was observed in patients with refractory variceal bleeding (91.1% vs. 92.2% transplant-free survival, p = 0.797).

Conclusion: This retrospective multicenter study provides first data indicating a beneficial effect of aspirin on transplant-free survival after TIPS implantation in patients with refractory ascites.

Keywords: Ascites; Aspirin; Complications of liver cirrhosis; Decompensated liver cirrhosis; Hepatic decompensation; Liver transplantation; Portal hypertension; Propensity score matching; Thrombocyte aggregation inhibition; Transjugular intrahepatic portosystemic shunt; Variceal bleeding.

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Conflict of interest statement

JT, speaking and consulting fees: Gore, Bayer, Alexion, MSD, Gilead, Intercept, Norgine, Grifols, Versantis, and Martin Pharmaceutical. DB: Consultant: Bayer Healthcare, Boston Scientific, Shionogi. Lectures: Falk Foundation. Leon Louis Seifert, Philipp Schindler, Lukas Sturm, Wenyi Gu, Quentin Edward Seifert, Jan Frederic Weller, Christian Jansen, Michael Praktiknjo, Carsten Meyer, Martin Schoster, Christian Wilms, Miriam Maschmeier, Hartmut H. Schmidt, Max Masthoff, Michael Köhler, Michael Schultheiss, Jan Patrick Huber, Dominik Bettinger, Jonel Trebicka, Moritz Wildgruber and Hauke Heinzow declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Patient selection and inclusion criteria
Fig. 2
Fig. 2
Transplant-free survival after TIPS implantation after PSM. A Transplant-free survival 12 months after TIPS-placement was 90.7% in the PSM-aspirin-cohort and 80.0% in the PSM-no-aspirin-cohort (Kaplan–Meier curve, p = 0.001, log-rank test). + , censored patients
Fig. 3
Fig. 3
Transplant-free survival by TIPS indication after PSM. a Transplant-free survival 12 months after TIPS-placement among patients with refractory ascites as TIPS indication was 89.6% in the PSM-aspirin-cohort and 70.6% in the PSM-no-aspirin-cohort (Kaplan–Meier curve, p < 0.001, log-rank test). b Transplant-free survival 12 months after TIPS-placement among patients with variceal bleeding as TIPS indication was 91.1% in the PSM-aspirin-cohort and 92.2% in the PSM-no-aspirin-cohort (Kaplan–Meier curve, p = 0.797, log-rank test). + , censored patients
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References

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