TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT IN HEPATORENAL-SYNDROME- EFFECTS ON RENAL-FUNCTION AND VASOACTIVE SYSTEMS

Little information exists on the effects of transjugular intrahepatic portosystemic shunts (TIPS) in the management of cirrhotic patients wi th hepatorenal syndrome (HRS). The current study was aimed to prospect ively evaluate the effects of TIPS on renal function and vasoactive sy stems in patients with type I HRS. Glomerular filtration rate (GFR) (i nulin clearance), renal plasma flow (RPF) (para-aminohippurate clearan ce), plasma renin activity (PRA), aldosterone (ALDO), norepinephrine ( NE), and endothelin (ET) were determined in baseline conditions and at different time intervals after TIPS in 7 patients with type I LIPS, T IPS induced a marked reduction of portal pressure gradient (PPG) (20 /- 1 to 10 +/- 1 mm Hg; P < .05). Renal function improved in 6 of the 7 patients. Serum creatinine and blood urea nitrogen (BUN) decreased f rom 5 +/- 0.8 and 109 +/- 7 to 1.8 +/- 0.4 mg/dL and 56 +/- 11 mg/dL, respectively (P < .05 for both), and GFR and RPF increased from 9 +/- 4 and 103 +/- 33 to 27 +/- 7 mL/min and 233 +/- 40 mL/min, respectivel y (P < .05 for both), 30 days after TIPS. These beneficial effects on renal function were associated with a significant (P < .05) reduction of PRA (18 +/- 5 to 3 +/- 1 ng/mL . h), ALDO (279 +/- 58 to 99 +/- 56 ng/dL), and NE (1,257 +/- 187 to 612 +/- 197 pg/mL). ET did not change significantly (28 +/- 8 to 27 +/- 11 pg/mL). Mean survival was 4.7 +/ - 2 months (0.3-17 months). Three patients remained alive more than 3 months after TIPS insertion. In conclusion, TIPS improves renal functi on and reduces the activity of the renin-angiotensin and sympathetic n ervous systems in cirrhotic patients with type I HRS. Nevertheless, th e efficacy of TIPS in the management of these patients should be confi rmed in controlled investigations.