Improved quality of life in patients with refractory or recidivant ascites after insertion of transjugular intrahepatic portosystemic shunts

Background. We have recently shown that the transjugular
intrahepatic portosystemic shunt (TIPS) is more effective than
paracentesis in the treatment of cirrhotic patients with severe
ascites and can prolong survival in selected patients. Although an
improved quality of life (QOL) has been suggested in these patients
after the TIPS procedure, so far there are no data available to
substantiate this assumption. Therefore, the aim of this study was
to determine the effect of TIPS on the QOL in cirrhotic patients
with refractory or recidivant ascites. Methods: 21 cirrhotic
patients who underwent TIPS for refractory or recidivant ascites
were investigated. All patients were pretreated with repeated
paracentesis for at least 1 year. Before the procedure and at 3 and
6 months during follow-up, the patients themselves rated QOL,
fatigue and physical performance on a visual analogue scale (range
0-100). Furthermore, QOL was determined by the QOL index (range
0-10) according to Spitzer. Results: Patients' rating of the QOL on
the visual analogue scale significantly increased from 35 +/- 25
(baseline) to 64 +/- 28 (3 months), and 66 +/- 24 (6 months; p =
0.02). Similarly, the QOL index significantly increased from 6.9
+/- 2.0 (baseline) to 8.3 +/- 2.1 (3 months), and 8.6 +/- 1.7 (6
months; p < 0.001). The increase of QOL was more pronounced in
patients with complete response to TIPS. Conclusions: We
demonstrate that TIPS for refractory or recidivant ascites improves
the QOL in patients with cirrhosis. Our data indicates that this
improvement is dependent on the response to therapy. Copyright (C)
2002 S. Karger AG, Basel.