Prognostic Impact of Renal Impairment and Sodium Imbalance in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunting for the Prevention of Variceal Rebleeding

Abstract

Background/Aim: Kidney function and portal pressure have prognostic relevance in nonshunted patients with cirrhosis. Since insertion of a transjugular intrahepatic portosystemic shunt (TIPS) reduces portal pressure and may improve the renal function, the aim of the present study was to investigate the prognostic role of renal impairment and portal hemodynamics in patients with compensated cirrhosis electively shunted due to recurrent variceal hemorrhages. Methods: Data of 101 consecutive and prospectively followed patients with compensated cirrhosis (bilirubin <5 mg/dl) undergoing elective TIPS due to recurrent variceal bleeding (45 died, and 8 were transplanted during the follow-up period) were evaluated in a multivariate Cox model. Results: Creatinine and sodium were identified as the only independent predictors of survival in this model. The 90th percentile of creatinine (>1.7 mg/dl) defined a subgroup with a similar poor prognosis as the 90th percentile of the model for end-stage liver disease (MELD) score. Neither baseline nor post-TIPS portal pressure correlated with the long-term outcome. Conclusions: In compensated patients undergoing TIPS due to variceal bleeding, renal impairment indicates a poor prognosis. Portal hemodynamic parameters are not predictive of survival in TIPS patients.

Transjugular intrahepatic portosystemic shunt placement for refractory ascites: a single-centre experience

“…This was not unexpected, since MELD was originally designed to predict mortality after TIPS [14]. Contrarily to other studies [3,18,19], in our population sodium level and creatinine were not independently associated with mortality. This may be due to the clinical protocols applied in our Hospital, which include the routine infusion of human albumin in cirrhotic patients with refractory ascites [20] leading to a significant improvement of renal function.…”

Renal failure and cirrhosis: A systematic review of mortality and prognosis

“…Renal failure is a frequent complication of advanced cirrhosis [1] due to several causes [3], and is associated with a high mortality [4,[14][15][16]. Furthermore, a pre-transplant renal impairment affects post-transplant survival [17].…”

Pros and cons of TIPS for refractory ascites

“…It has been reported that TIPS can improve type II hepatorenal syndrome [8]. However, these data are contrary to other studies which demonstrate that a high serum creatinine is a powerful predictor of a poor outcome after TIPS [9]. It is therefore prudent at this time to reserve TIPS for those with refractory ascites and a serum creatinine !2 mg/dl.…”