Top

Current Hepatology Reports

Published in:

01-06-2019 | Hepatic Encephalopathy | Portal Hypertension (J Gonzalez-Abraldes and E Tsochatzis, Section Editors)

Patient Selection in Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Refractory Ascites and Associated Conditions

Authors: Beverley Kok, Juan Gonzalez Abraldes

Published in: Current Hepatology Reports | Issue 2/2019

Abstract

Purpose of Review

This review summarizes the key developments and latest evidence for transjugular intrahepatic portosystemic shunt (TIPS) for the indications of refractory ascites and related conditions, as well as factors that should be taken into consideration with regard to patient selection.

Recent Findings

Recent evidence from randomized controlled studies has suggested that the early institution of TIPS in well-selected patients with refractory ascites may confer a survival benefit. Increasing evidence is also mounting on the potential role of TIPS in improving and reversing hepatorenal syndrome.

Summary

TIPS has conventionally been sought as a second-line treatment for refractory ascites. Recent evidence has suggested a potential survival benefit with early TIPS in well-compensated patients for this indication; this may lead to a paradigm shift for TIPS to be considered as primary therapy in well-selected “low-risk” patients. In hepatorenal syndrome, while evidence on TIPS is limited, multiple studies have shown a serendipitous improvement to renal function in both type 1 and 2 hepatorenal syndrome following TIPS.

Boyer TD, Haskal ZJ. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology (Baltimore, Md). 2010;51(1):306. https://doi.org/10.1002/hep.23383.CrossRef

Gines P, Cardenas A, Arroyo V, Rodes J. Management of cirrhosis and ascites. N Engl J Med. 2004;350(16):1646–54. https://doi.org/10.1056/NEJMra035021.CrossRefPubMed

Gines P, Arroyo V, Vargas V, Planas R, Casafont F, Panes J, et al. Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. N Engl J Med. 1991;325(12):829–35. https://doi.org/10.1056/nejm199109193251201.CrossRefPubMed

Gines P, Uriz J, Calahorra B, Garcia-Tsao G, Kamath PS, Del Arbol LR, et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology. 2002;123(6):1839–47. https://doi.org/10.1053/gast.2002.37073.CrossRefPubMed

Deltenre P, Mathurin P, Dharancy S, Moreau R, Bulois P, Henrion J, et al. Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta-analysis. Liver Int. 2005;25(2):349–56. https://doi.org/10.1111/j.1478-3231.2005.01095.x.CrossRefPubMed

Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology (Baltimore, Md). 1996;23(1):164–76. https://doi.org/10.1002/hep.510230122.CrossRef

Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology (Baltimore, Md). 2003;38(1):258–66. https://doi.org/10.1053/jhep.2003.50315.CrossRef

Albillos A, Banares R, Gonzalez M, Catalina MV, Molinero LM. A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites. J Hepatol. 2005;43(6):990–6. https://doi.org/10.1016/j.jhep.2005.06.005.CrossRefPubMed

Saab S, Nieto JM, Lewis SK, Runyon BA. TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database Syst Rev. 2006;(4):Cd004889. https://doi.org/10.1002/14651858.CD004889.pub2.

10.

Lebrec D, Giuily N, Hadengue A, Vilgrain V, Moreau R, Poynard T, et al. Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. French Group of Clinicians and a Group of Biologists. J Hepatol. 1996;25(2):135–44.CrossRefPubMed

11.

Rossle M, Ochs A, Gulberg V, Siegerstetter V, Holl J, Deibert P, et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med. 2000;342(23):1701–7. https://doi.org/10.1056/nejm200006083422303.CrossRefPubMed

12.

Sanyal AJ, Genning C, Reddy KR, Wong F, Kowdley KV, Benner K, et al. The North American study for the treatment of refractory ascites. Gastroenterology. 2003;124(3):634–41. https://doi.org/10.1053/gast.2003.50088.CrossRefPubMed

13.

Salerno F, Merli M, Riggio O, Cazzaniga M, Valeriano V, Pozzi M, et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Hepatology (Baltimore, Md). 2004;40(3):629–35. https://doi.org/10.1002/hep.20364.CrossRef

14.

Narahara Y, Kanazawa H, Fukuda T, Matsushita Y, Harimoto H, Kidokoro H, et al. Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial. J Gastroenterol. 2011;46(1):78–85. https://doi.org/10.1007/s00535-010-0282-9.CrossRefPubMed

15.

Bai M, Qi XS, Yang ZP, Yang M, Fan DM, Han GH. TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: an updated meta-analysis. World J Gastroenterol. 2014;20(10):2704–14. https://doi.org/10.3748/wjg.v20.i10.2704.CrossRefPubMedPubMedCentral

16.

•• Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology. 2017;152(1):157–63. https://doi.org/10.1053/j.gastro.2016.09.016 French multi-centre RCT indicating improved transplant-free survival with TIPS vs LVP in well-compensated patients, with no increase in episodes of HE.CrossRefPubMed

17.

Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology (Baltimore, Md). 2000;31(4):864–71. https://doi.org/10.1053/he.2000.5852.CrossRef

18.

Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology (Baltimore, Md). 2004;40(1):55–64. https://doi.org/10.1002/hep.20262.CrossRef

19.

Brensing KA, Textor J, Perz J, Schiedermaier P, Raab P, Strunk H, et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study. Gut. 2000;47(2):288–95.CrossRefPubMedPubMedCentral

20.

D'Amico G, Luca A, Morabito A, Miraglia R, D'Amico M. Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis. Gastroenterology. 2005;129(4):1282–93. https://doi.org/10.1053/j.gastro.2005.07.031.CrossRefPubMed

21.

Rajan DK, Haskal ZJ, Clark TW. Serum bilirubin and early mortality after transjugular intrahepatic portosystemic shunts: results of a multivariate analysis. J Vasc Interv Radiol : JVIR. 2002;13(2 Pt 1):155–61.CrossRefPubMed

22.

Gerbes AL, Gulberg V. Benefit of TIPS for patients with refractory or recidivant ascites: serum bilirubin may make the difference. Hepatology (Baltimore, Md). 2005;41(1):217. https://doi.org/10.1002/hep.20509.CrossRef

23.

Gulberg V, Liss I, Bilzer M, Waggershauser T, Reiser M, Gerbes AL. Improved quality of life in patients with refractory or recidivant ascites after insertion of transjugular intrahepatic portosystemic shunts. Digestion. 2002;66(2):127–30. https://doi.org/10.1159/000065593.CrossRefPubMed

24.

Campbell MS, Brensinger CM, Sanyal AJ, Gennings C, Wong F, Kowdley KV, et al. Quality of life in refractory ascites: transjugular intrahepatic portal-systemic shunting versus medical therapy. Hepatology (Baltimore, Md). 2005;42(3):635–40. https://doi.org/10.1002/hep.20840.CrossRef

25.

Wong F, Sniderman K, Liu P, Blendis L. The mechanism of the initial natriuresis after transjugular intrahepatic portosystemic shunt. Gastroenterology. 1997;112(3):899–907.CrossRefPubMed

26.

Pieper CC, Jansen C, Meyer C, Nadal J, Lehmann J, Schild HH, et al. Prospective evaluation of passive expansion of partially dilated transjugular intrahepatic portosystemic shunt stent grafts-a three-dimensional sonography study. J Vasc Interv Radiol: JVIR. 2017;28(1):117–25. https://doi.org/10.1016/j.jvir.2016.06.023.CrossRefPubMed

27.

Bureau C, Garcia-Pagan JC, Otal P, Pomier-Layrargues G, Chabbert V, Cortez C, et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology. 2004;126(2):469–75.CrossRef

28.

Bellis L, Moitinho E, Abraldes JG, Graupera M, Garcia-Pagan JC, Rodes J, et al. Acute propranolol administration effectively decreases portal pressure in patients with TIPS dysfunction. Transjugular intrahepatic portosystemic shunt. Gut. 2003;52(1):130–3.CrossRefPubMedPubMedCentral

29.

Wannhoff A, Hippchen T, Weiss CS, Friedrich K, Rupp C, Neumann-Haefelin C, et al. Cardiac volume overload and pulmonary hypertension in long-term follow-up of patients with a transjugular intrahepatic portosystemic shunt. Aliment Pharmacol Ther. 2016;43(9):955–65. https://doi.org/10.1111/apt.13569.CrossRefPubMed

30.

Shah RP, Sze DY. Complications during transjugular intrahepatic portosystemic shunt creation. Tech Vasc Interv Radiol. 2016;19(1):61–73. https://doi.org/10.1053/j.tvir.2016.01.007.CrossRefPubMed

31.

Suhocki PV, Lungren MP, Kapoor B, Kim CY. Transjugular intrahepatic portosystemic shunt complications: prevention and management. Semin Interv Radiol. 2015;32(2):123–32. https://doi.org/10.1055/s-0035-1549376.CrossRef

32.

Bureau C, Garcia Pagan JC, Layrargues GP, Metivier S, Bellot P, Perreault P, et al. Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study. Liver Int. 2007;27(6):742–7. https://doi.org/10.1111/j.1478-3231.2007.01522.x.CrossRefPubMed

33.

Bai M, Qi X, Yang Z, Yin Z, Nie Y, Yuan S, et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: a systematic review. J Gastroenterol Hepatol. 2011;26(6):943–51. https://doi.org/10.1111/j.1440-1746.2011.06663.x.CrossRefPubMed

34.

Casado M, Bosch J, Garcia-Pagan JC, Bru C, Banares R, Bandi JC, et al. Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology. 1998;114(6):1296–303.CrossRefPubMed

35.

Silva-Junior G, Turon F, Baiges A, Cerda E, Garcia-Criado A, Blasi A, et al. Timing affects measurement of portal pressure gradient after placement of transjugular intrahepatic portosystemic shunts in patients with portal hypertension. Gastroenterology. 2017;152(6):1358–65. https://doi.org/10.1053/j.gastro.2017.01.011.CrossRefPubMed

36.

Harrod-Kim P, Saad WE, Waldman D. Predictors of early mortality after transjugular intrahepatic portosystemic shunt creation for the treatment of refractory ascites. J Vasc Int Radiol: JVIR. 2006;17(10):1605–10. https://doi.org/10.1097/01.rvi.0000240651.38289.4b.CrossRef

37.

Riggio O, Merlli M, Pedretti G, Servi R, Meddi P, Lionetti R, et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Incidence and risk factors. Dig Dis Sci. 1996;41(3):578–84.CrossRefPubMed

38.

•• Schepis F, Vizzutti F, Garcia-Tsao G, Marzocchi G, Rega L, De Maria N, et al. Under-dilated TIPS associate with efficacy and reduced encephalopathy in a prospective, non-randomized study of patients with cirrhosis. Clin Gastroenterol Hepatol. 2018;16(7):1153–62.e7. https://doi.org/10.1016/j.cgh.2018.01.029 Novel study indicating that underdilation of TIPS to 6mm may result in reduced episodes of HE without compromising efficacy in reducing LVP requirements. CrossRef

39.

De Keyzer B, Nevens F, Laenen A, Heye S, Laleman W, Verslype C, et al. Percutaneous shunt reduction for the management of TIPS-induced acute liver decompensation: a follow-up study. Ann Hepatol. 2016;15(6):911–7. https://doi.org/10.5604/16652681.1222110.CrossRefPubMed

40.

Parvinian A, Shah KD, Couture PM, Minocha J, Knuttinen MG, Bui JT, et al. Older patient age may predict early mortality after transjugular intrahepatic portosystemic shunt creation in individuals at intermediate risk. J Vasc Interv Radiol: JVIR. 2013;24(7):941–6. https://doi.org/10.1016/j.jvir.2013.03.018.CrossRefPubMed

41.

Busk TM, Bendtsen F, Henriksen JH, Fuglsang S, Clemmesen JO, Larsen FS, et al. Effects of transjugular intrahepatic portosystemic shunt (TIPS) on blood volume distribution in patients with cirrhosis. Dig Liver Dis. 2017;49:1353–9. https://doi.org/10.1016/j.dld.2017.06.011.CrossRefPubMed

42.

Cazzaniga M, Salerno F, Pagnozzi G, Dionigi E, Visentin S, Cirello I, et al. Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt. Gut. 2007;56(6):869–75. https://doi.org/10.1136/gut.2006.102467.CrossRefPubMedPubMedCentral

43.

Shounak M, Vimal R, Colin S, David IS. A retrospective analysis of the impact of diastolic dysfunction on one-year mortality after transjugular intrahepatic porto-systemic shunt, liver transplantation and non-transplant abdominal surgery in patients with cirrhosis. Ann Gastroenterol. 2015;28(3):385–90.PubMedPubMedCentral

44.

Bhattacharya A, Mittal BR, Biswas T, Dhiman RK, Singh B, Jindal SK, et al. Radioisotope scintigraphy in the diagnosis of hepatic hydrothorax. J Gastroenterol Hepatol. 2001;16(3):317–21.CrossRefPubMed

45.

Badillo R, Rockey DC. Hepatic hydrothorax: clinical features, management, and outcomes in 77 patients and review of the literature. Medicine. 2014;93(3):135–42. https://doi.org/10.1097/md.0000000000000025.CrossRefPubMedPubMedCentral

46.

Orman ES, Lok AS. Outcomes of patients with chest tube insertion for hepatic hydrothorax. Hepatol Int. 2009;3(4):582–6. https://doi.org/10.1007/s12072-009-9136-z.CrossRefPubMedPubMedCentral

47.

Runyon BA, Greenblatt M, Ming RH. Hepatic hydrothorax is a relative contraindication to chest tube insertion. Am J Gastroenterol. 1986;81(7):566–7.PubMed

48.

Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology (Baltimore, Md). 2013;57(4):1651–3. https://doi.org/10.1002/hep.26359.CrossRef

49.

Ditah IC, Al Bawardy BF, Saberi B, Ditah C, Kamath PS. Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: a systematic review and cumulative meta-analysis. World J Hepatol. 2015;7(13):1797–806. https://doi.org/10.4254/wjh.v7.i13.1797.CrossRefPubMedPubMedCentral

50.

Young S, Bermudez J, Zhang L, Rostambeigi N, Golzarian J. Transjugular intrahepatic portosystemic shunt (TIPS) placement: a comparison of outcomes between patients with hepatic hydrothorax and patients with refractory ascites. Diagn Interv Imaging. 2018. https://doi.org/10.1016/j.diii.2018.10.006.

51.

Salerno F, Gerbes A, Gines P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56(9):1310–8. https://doi.org/10.1136/gut.2006.107789.CrossRefPubMedPubMedCentral

52.

Testino G, Ferro C, Sumberaz A, Messa P, Morelli N, Guadagni B, et al. Type-2 hepatorenal syndrome and refractory ascites: role of transjugular intrahepatic portosystemic stent-shunt in eighteen patients with advanced cirrhosis awaiting orthotopic liver transplantation. Hepato-gastroenterology. 2003;50(54):1753–5.PubMed

53.

Alessandria C, Venon WD, Marzano A, Barletti C, Fadda M, Rizzetto M. Renal failure in cirrhotic patients: role of terlipressin in clinical approach to hepatorenal syndrome type 2. Eur J Gastroenterol Hepatol. 2002;14(12):1363–8.CrossRefPubMed

54.

Allegretti AS, Ortiz G, Cui J, Wenger J, Bhan I, Chung RT, et al. Changes in kidney function after transjugular intrahepatic portosystemic shunts versus large-volume paracentesis in cirrhosis: a matched cohort analysis. Am J Kidney Dis. 2016;68(3):381–91. https://doi.org/10.1053/j.ajkd.2016.02.041. CrossRefPubMedPubMedCentral

55.

Anderson CL, Saad WE, Kalagher SD, Caldwell S, Sabri S, Turba UC, et al. Effect of transjugular intrahepatic portosystemic shunt placement on renal function: a 7-year, single-center experience. J Vasc Interv Radiol: JVIR. 2010;21(9):1370–6. https://doi.org/10.1016/j.jvir.2010.05.009.CrossRefPubMed

56.

Angeli P, Bernadi M, Villanueva C, Francoz C, Mookerjee R, Trebicka J, Krag A, Laleman W, Gines P. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–60. https://doi.org/10.1016/j.jhep.2018.03.024.

57.

Gluud LL, Christensen K, Christensen E, Krag A. Terlipressin for hepatorenal syndrome. Cochrane Database Syst Rev. 2012;(9):Cd005162. https://doi.org/10.1002/14651858.CD005162.pub3.

58.

Gines P, Angeli P, Lenz K, Moller S, Moore K, Moreau R, Merkel C, Ring-Larsen H, Bernardi M. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53(3):397–417. https://doi.org/10.1016/j.jhep.2010.05.004.

59.

Moreau R, Durand F, Poynard T, Duhamel C, Cervoni JP, Ichai P, et al. Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology. 2002;122(4):923–30.CrossRefPubMed

60.

Guevara M, Gines P, Bandi JC, Gilabert R, Sort P, Jimenez W, et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems. Hepatology (Baltimore, Md). 1998;28(2):416–22. https://doi.org/10.1002/hep.510280219.CrossRef

61.

• Song T, Rossle M, He F, Liu F, Guo X, Qi X. Transjugular intrahepatic portosystemic shunt for hepatorenal syndrome: a systematic review and meta-analysis. Dig Liver Dis. 2018;50(4):323–30. https://doi.org/10.1016/j.dld.2018.01.123 . Systematic review showing limited evidence of potential survival benefit in patients with hepatorenal syndrome treated with TIPS.CrossRefPubMed

Title: Patient Selection in Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Refractory Ascites and Associated Conditions
Authors: Beverley Kok
Juan Gonzalez Abraldes
Publication date: 01-06-2019
Publisher: Springer US
Keywords: Hepatic Encephalopathy
Hepatorenal Syndrome
Ascites
Hepatic Encephalopathy
Hepatorenal Syndrome
Published in: Current Hepatology Reports / Issue 2/2019
Electronic ISSN: 2195-9595
DOI: https://doi.org/10.1007/s11901-019-00470-4

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 2/2019

Acute HCV Treatment: What Should We Do in the DAA Era?

Management of Fatigue in Primary Biliary Cholangitis

The Role of Hepatic and Splanchnic Lymphatic System in Portal Hypertension and Ascites

Novel Targets and Drug Development in Portal Hypertension

Non-invasive Fibrosis Assessment of Patients with Hepatitis C: Application of Society Guidelines to Clinical Practice

Prediction of Decompensation in Patients with Compensated Cirrhosis: Does Etiology Matter?

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage