Transjugular intrahepatic portosystemic shunt for cirrhosis and ascites: Effects in patients with organic or functional renal failure

Background: A transjugular intrahepatic portosystemic shunt (TIPS) is incre asingly bring used for treatment of patients with refractory ascites and fu nctional renal failure. In contrast, organic renal disease is commonly cons idered a relative contraindication for TIPS placement. The aim of this pilo t study was to investigate the effects of TIPS in patients with refractory ascites and organic or functional renal impairment. Methods: A TIPS was pla ced for refractory or intractable ascites in 10 consecutive patients with l iver cirrhosis and impaired renal function (serum creatinine >1.5 mg/100 ml ). Four of them had organic kidney disorders. Of these patients, three had moderate renal impairment, and one had end-stage renal disease and needed h emodialysis every other day. The other six patients had functional renal im pairment due to the underlying liver disease. Results: TIPS was effective i n reducing ascites in 8 of 10 patients, including all patients with organic renal disease. Furthermore, after TIPS the renal function improved in all patients. Serum creatinine and serum urea levels decreased significantly fr om 1.8 +/- 0.1 to 1.5 +/- 0.1 mg/100 ml (P < 0.05) and from 107 +/- 13 to 7 8 +/- 14 mg/100 ml (P < 0.05), respectively. The renal function of the thre e patients with organic renal failure improved similarly, as observed in th e six patients with functional renal failure. In the patient on hemodialysi s, TIPS was effective in reducing the frequency of paracenteses. Conclusion : TIPS may be useful in patients with functional and in patients with organ ic renal disease, resulting in improvement of ascites and renal function.