Transjugular intrahepatic portosystemic shunt implantation improves renal function in patients with ascites

Background and Aims:

The implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment option for complications of portal hypertension, but may also improve renal function.

Method:

In this single-center study, we retrospectively assessed serum creatinine (sCr) as a marker for renal function at baseline (3 to 0 days prior to TIPS), and at 1 week (W1, 3 – 10 days), 3 months (M3), and 6 months (M6) after TIPS implantation in patients with cirrhosis.

Legend:
Black, continuous line: Indication ascites (n = 111)
Grey, interrupted line: Indication variceal bleeding (n = 89)
* p < 0.05
** n = 73 patients with ascites and n = 61 patients with variceal bleeding

Results:

200 patients were included: etiology: 71.5% alcoholic; gender: 76.0% male; age: mean 55.6 (SD ± 10) years; MELD: 12.9 ± 3.8; TIPS: 79.5% covered stent grafts; indication: 40% variceal bleeding (VB), 55.5% ascites, 4.5% bleeding+ascites. Patients with refractory ascites were older than those with VB (57.4 ± 8.8 vs. 53.4 ± 10.8 years; p = 0.002), but hepatic function was comparable (MELD 12.8 ± 3.7 vs. 13.3 ± 3.9; p = 0.506). Median baseline sCr was 1.06 (range: 0.38 – 5.88)mg/dL. sCr values were higher in patients with ascites than in those with VB [baseline: 1.29 (0.38 – 5.88)mg/dL vs. 0.90 (0.39 – 2.65)mg/dL; p < 0.0001]. sCr significantly decreased in patients with ascites in the first 3 – 10 days after TIPS implantation (median -13.4% (range:-64%- +213%), p = 0.002). Afterwards, sCr mostly remained stable [rel. changes W1-M3: ascites: -1.44% (-73.47%- +335.3%), p = 0.372; bleeding: +1.23% (-98.39%- +142.4%), p > 0.999].

Conclusion:

TIPS implantation improves renal function within the first 3 – 10 days, but only in patients with ascites. However, results may be biased due to the retrospective design. Further prospective studies are required.