Acute effects of transjugular intrahepatic portosystemic stent-shunt (TIPSS) procedure on renal blood flow and cardiopulmonary hemodynamics in cirrhosis

Objective: An acute increase in portal pressure is associated with an immed iate reduction in renal blood flow. It has been suggested that this support s the presence of an hepatorenal reflex. In this study, we used TIPSS place ment as a model to investigate the effect of an acute reduction in portal p ressure on renal blood flow and cardiopulmonary hemodynamic parameters. Met hods: Eleven cirrhotic patients were studied during elective TIPSS placemen t for variceal hemorrhage (n = 9) or refractory ascites (n = 2). Unilateral renal blood flow (RBF) was measured before and at 5, 15, 30, 45, and 60 mi n after shunt insertion. Heart rate (HR), mean arterial pressure (MAP), rig ht atrial pressure (RAP), mean pulmonary artery pressure (PAP), pulmonary c apillary wedge pressure (PCWP), cardiac output (CO), and systemic vascular resistance (SVR) were also measured before and 30 min after TIPSS placement . Results: Despite significant increases in CO (p = 0.001), RAP (p < 0.001) , PAP (p < 0.001), and PCWP (p = 0.001), and a fall in SVR (p = 0.003), no change was observed in RBF, HR, or MAP after TIPSS placement. The fall in t he portoatrial pressure gradient correlated only with the rise in CO (p < 0 .05) and the drop in SVR (p < 0.05). Conclusion: Despite the fall in portal pressure and the systemic hemodynamic changes caused by TIPSS placement, t here is no immediate effect on RBF. Any improvement in renal function after TIPSS procedure does not appear to be due to an acute increase in RBF. (C) 1998 by Am. Cell. of Gastroenterology.