Strategies to improve adherence to interventions {11c}
ascites, bleeding, esophageal bleeding, infection, AKI, variceal bleeding, TIPS
ASCITES, BLEEDING, ESOPHAGEAL BLEEDING, MASSIVE BLEEDING, INFECTION, SECONDARY
Given the dynamic nature of AKI-HRS, no specific measures can be applied to avoid T-to-C switchers, besides strict application of the inclusion and exclusion criteria. In order to avoid C-to-T switchers, specific criteria for the placement of TIPS (control group) or revision of TIPS (intervention group) have been specified. TIPS placement and TIPS revision are indicated in the case of development of:Massive bleeding requiring placement of an ELLA Danis stent or Sengstaken-Blakemore or Linton balloon (emergency TIPS)Esophageal variceal bleeding (in patients with Child–Pugh B 7–9 points and active bleeding at endoscopy or patients with Child–Pugh C 10–13 points) (pre-emptive TIPS)Recurrent esophageal bleeding despite adequate secondary prophylaxis with beta-blockers and endoscopic band ligationRefractory ascites as defined by the IAC (see Ch. 14.3) [Recurrent ascites as defined by the need of 3 large paracenteses within 3 months (in a stable situation). Only paracentesis that takes place in a stable situation, namely without concurrent infection, without AKI, without bleeding, etc., will be considered [If a patient randomized into the control group develops an indication for TIPS (except emergency TIPS or pre-emptive TIPS) during follow-up, the treating study physician should consult the Principal Coordinating Investigator to discuss the indication before TIPS implantation.