TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS FOR REFRACTORY ASCITES- ASSESSMENT OF CLINICAL AND HORMONAL RESPONSE AND RENAL-FUNCTION

Cirrhosis is frequently complicated by ascites that may become resista nt to diuretic therapy. Transjugular intrahepatic portosystemic shunts (TIPS) represent a new treatment for this debilitating condition, The aim of this study was to ascertain the clinical efficacy of TIPS, as well as its impact on renal function and on hormonal parameters. Five inpatients with refractory ascites were studied prospectively before T IPS, and 3 and 14 days after TIPS, After TIPS, ascites completely reso lved or was minimal in all patients, Diuretics were discontinued in th ree subjects and decreased by at least 50% in two. One patient develop ed liver failure after TIPS and required Liver transplantation; the ot hers remained stable after a mean follow-up of 14 months. Mean urinary sodium excretion increased from 2.1 +/- 0.6 mEq/ 24 hr before TIPS to 13.0 +/- 4.3 mEq/24 hr 14 days after TIPS. Mean serum creatinine and glomerular filtration rate also tended to improve during the study per iod. With the exception of the patient who developed liver failure, pl asma aldosterone concentration decreased from a mean of 126.0 +/- 29.9 ng/dL to 22.8 +/- 6.8 ng/dL (P = .04), and plasma renin activity decr eased from a mean of 9.0 +/- 3.0 mu g/L/h to 0.9 +/- 0.1 mu g/L/h (P = .08). Additionally, 19 patients who underwent TIPS for refractory asc ites outside of this protocol were followed prospectively for a mean o f 282 days, Clinical improvement in ascites control was noted in 74%, and the mean dose of diuretics was decreased by more than 50%. Nonresp onders more often had underlying renal disease, In conclusion, TIPS is an effective therapy for refractory ascites in most patients. TIPS im proves renal function and in most patients reverses underlying hormona l derangements. TIPS may have an adverse effect on hepatic function, n ecessitating careful patient selection.