TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTING IMPROVES SPLANCHNIC HEMODYNAMICS AND RENAL NA EXCRETION IN CIRRHOSIS WITH REFRACTORY ASCITES

To clarify the pathogenesis of ascites in patients with liver cirrhosi s, we explored the effects of transjugular intrahepatic portosystemic shunting in six cirrhotic patients with refractory ascites. The portal pressure decreased from 39 +/- 7 cmH(2)O before treatment to 32 +/- 5 cmH(2)O immediately after the procedure. Liver function transiently d eteriorated after the procedure, but recovered within 1 week. Urinary Na excretion increased 1 week after treatment. In five patients, ascit es improved within 3 weeks. Along with the decrease of portal congesti on, there was an improvement of esophageal varices, and an increase of gastric mucosal blood flow, and an inhibition of the renin-angiotensi n-aldosterone system in all of the patients after 2-4 weeks. Manageabl e shunt encephalopathy occurred in three patients. These findings stro ngly suggest the pivotal role of increased portal pressure in the form ation of ascites in patients with liver cirrhosis.