Early TIPS in Patients With Liver Cirrhosis and Ascites
Early Implantation of a Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Patients With Liver Cirrhosis and Ascites: a Multicentre, Randomised Controlled Trial
University Hospital Freiburg
134 participants
Apr 1, 2025
INTERVENTIONAL
Conditions
Summary
The aim of this clinical trial is to compare the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) implantation with standard treatment (diuretic medications, and if necessary, paracenteses) in patients with liver cirrhosis and development of ascites as the first decompensating event. By creating a shunt between the liver vein and the portal vein, blood is diverted from the portal vein directly into the hepatic vein, which results in a reduction of pressure in the portal vein so that development of ascites is reduced.
Eligibility
Inclusion Criteria6
- Patients eligible for inclusion in this trial must meet all of the following criteria:
- Patients ≥ 18 years and \< 80 years
- Liver cirrhosis as documented by previous liver biopsy or by a combination of typical clinical, biochemical and sonographic features
- Ascites as the first single decompensating event with grade 2 ascites and MELD ≥ 15 OR grade 3 ascites
- INR ≤ 1.5
- Ability to understand the nature of the trial and the trial related procedures and to comply with them
Exclusion Criteria29
- Patients eligible for this trial must not meet any of the following criteria:
- Treatment refractory or recurrent ascites at the time of study inclusion
- Patients with concomitant variceal bleeding fulfilling the criteria for pre-emptive TIPS implantation (Child-Pugh class C \< 14 points or Child-Pugh class B \>7 with active bleeding at initial endoscopy or hepatic venous pressure gradient \[HVPG\] \> 20 mmHg at the time of bleeding)
- Budd-Chiari syndrome
- Portal vein thrombosis (PVT)
- Spontaneous bacterial peritonitis (SBP)
- Uncontrolled systemic infection (defined as an increase of \> 20% if inflammatory parameters \[C-reactive protein, procalcitonin, leukocytes\] and/or sepsis as a reason for development of ascites
- Cardiac cirrhosis (defined as the development of liver cirrhosis in a patient with cardiac heart failure due to primary cardiac disease)
- Clinical significant cardiac disease (NYHA ≥II)
- Untreated valvular heart disease: middle to high-grade valve stenosis or insufficiency (applies to mitral, tricuspid, aortic and pulmonary valves)
- Diastolic dysfunction grade III, stated by transthoracic echocardiogram (TTE)
- Reduced left ventricular ejection fraction ≤50%
- Pulmonary hypertension (mean pulmonary arterial pressure \> 45 mmHg)
- Bilirubin \> 3 mg/dl
- Obstructive cholestasis
- Hepatorenal syndrome type AKI (HRS-AKI)
- Acute on chronic liver failure
- Benign liver tumor within the potential puncture tract
- Patient after liver transplantation
- Prior TIPS implantation
- Ongoing and/or recurrent hepatic encephalopathy (grade \>II)
- Active tumor disease including hepatocellular carcinoma defined as need for chemotherapy, radiation therapy, interventional or surgical treatment
- New onset of antiviral treatment for chronic hepatitis B virus (HBV) infection within the last 3 months
- Untreated chronic hepatitis C virus (HCV) infection
- Life expectancy \<1 year
- Pregnant or breastfeeding women
- Patients without the legal capacity who are unable to understand the nature, significance and consequences of the study
- Simultaneous participation in other interventional trials which could interfere with this trial; simultaneous participation in registry and diagnostic trials is allowed
- Person who is in a relationship of dependence/employment with the sponsor or the investigator
Interventions
TIPS implantation is performed by creating a shunt between the liver vein and the portal vein to enable portal pressure reduction.
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT06576934