Z Gastroenterol 2021; 59(08): e348
DOI: 10.1055/s-0041-1734281
POSTER
Hepatologie

Covered TIPS improves renal function in patients with cirrhosis and ascites

TA Müllner-Bucsics
1   Medical University of Vienna, Dpt. of Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Laboratory, Vienna Liver Study Groups, Dpt. of Medicine III, Vienna, Austria
,
K Schönhofer
1   Medical University of Vienna, Dpt. of Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
,
M Schoder
3   Medical University of Vienna, Dpt. of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
,
JP Jonas
4   Klinik Favoriten, Dpt. of Surgery, Vienna, Austria
,
D Bauer
1   Medical University of Vienna, Dpt. of Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Laboratory, Vienna Liver Study Groups, Dpt. of Medicine III, Vienna, Austria
,
L Hartl
1   Medical University of Vienna, Dpt. of Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Laboratory, Vienna Liver Study Groups, Dpt. of Medicine III, Vienna, Austria
,
M Jachs
1   Medical University of Vienna, Dpt. of Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Laboratory, Vienna Liver Study Groups, Dpt. of Medicine III, Vienna, Austria
,
F Wolf
3   Medical University of Vienna, Dpt. of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
,
J Karner
4   Klinik Favoriten, Dpt. of Surgery, Vienna, Austria
,
F Karnel
5   Klinik Favoriten, Dpt. of Radiology, Vienna, Austria
,
T Grünberger
4   Klinik Favoriten, Dpt. of Surgery, Vienna, Austria
,
M Trauner
1   Medical University of Vienna, Dpt. of Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
,
M Mandorfer
1   Medical University of Vienna, Dpt. of Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Laboratory, Vienna Liver Study Groups, Dpt. of Medicine III, Vienna, Austria
,
T Reiberger
1   Medical University of Vienna, Dpt. of Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Laboratory, Vienna Liver Study Groups, Dpt. of Medicine III, Vienna, Austria
6   Medical University of Vienna, Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Vienna, Austria
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    Background and Aims Guidelines suggest implantating a transjugular intrahepatic portosystemic shunt (TIPS) in patients with recurrent/refractory ascites who are at risk for hepatorenal syndrome (HRS). However, data on the course and risk of HRS after TIPS are limited.

    Methods Patients with cirrhosis undergoing covered TIPS implantation for ascites were included. Serum creatinine (sCr) and blood urea nitrogen (BUN) were recorded prior to TIPS (baseline, BL), within 2-7 days after TIPS, and at 1, 3, 6 and 12 months (M1/M3/M6/M12) after TIPS.

    Results 165 patients were included: male: 75.2 %, mean age: 58.4±9.2 years, Child-C: 18.8 %, median MELD: 13 (range: 6-30). BUN improved consistently and significantly from median BL 26.9(IQR: 18.0-39.2)mg/dL to 16.0(12.2-22.6)mg/dL at M12 (P<0.0001). sCr decreased from median 1.19(IQR: 0.91-1.60)mg/dL at BL to 0.92(0.79-1.20)mg/dL at M12 (P=0.0048). SCr improved mostly in patients with HRS (i.e. sCr>1.5mg/dL; n = 35) from BL 1.82(1.52-2.15)mg/dL to 1.22mg/dL(0.95-1.54) at M3 (P=0.009), and in patients with BL-sCr of 1.2-1.5mg/dL to 0.95(0.85-1.06)mg/dL at M6 (P=0.024), but remained stable in patients with <1.2mg/dL at BL (P=0.424). Overall, renal function improved (sCr decrease by >0.3mg/dL) in 83.3 % of HRS-patients and in 61.8 % of patients with BL-sCr 1.2-1.5mg/dL. Diuretic treatment was reduced in 44.8 % (60.0 % of HRS) at the next clinical visit after TIPS, while 25.5 % (32.4 % of HRS patients) still required paracenteses. Post-TIPS acute kidney injury was uncommon and often preceded by non-TIPS related triggers (11/20). BL-sCr and BL-BUN did not impact on post-TIPS transplant-free survival (TFS, P>0.05 for both), but TFS was significantly longer in patients who resolved HRS (median 1014(154-3788)days) than in those who did not (41(30-660)days, P=0.039).

    Conclusion TIPS implantation significantly improves renal function and ascites control in patients with recurrent/refractory ascites and HRS. Pre-TIPS renal function parameters did not influence transplant-free mortality after TIPS. Acute kidney injury after TIPS was mostly precipitated by non-TIPS related complications.


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    Artikel online veröffentlicht:
    01. September 2021

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