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

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 (DAA). 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.