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Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study
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  1. K A Brensinga,
  2. J Textorb,
  3. J Perza,
  4. P Schiedermaiera,
  5. P Raaba,
  6. H Strunkb,
  7. H U Klehra,
  8. H J Kramera,
  9. U Spenglera,
  10. H Schildb,
  11. T Sauerbrucha
  1. aDepartment of Internal Medicine, University of Bonn, Sigmund-Freud-Straβe 25, 53105 Bonn, Germany, bDepartment of Radiology, University of Bonn, Sigmund-Freud-Straβe 25, 53105 Bonn, Germany
  1. Dr T Sauerbruch Email: sauerbruch{at}uni-bonn.de

Abstract

BACKGROUND Recent small studies on hepatorenal syndrome (HRS) indicate some clinical benefit after transjugular intrahepatic portosystemic stent-shunt (TIPS) but sufficient long term data are lacking.

AIM We studied prospectively feasibility, safety, and long term survival after TIPS in 41 non-transplantable cirrhotics with HRS (phase II study).

PATIENTS AND METHODS HRS was diagnosed using current criteria (severe (type I) HRS, n=21; moderate (type II) HRS, n=20). Thirty one patients (14 type I, 17 type II) received TIPS (8–10 mm) while advanced liver failure excluded shunting in 10. During follow up (median 24 months) we analysed renal function and survival (Kaplan-Meier).

RESULTS TIPS markedly reduced the portal pressure gradient (21 (5) to 13 (4) mm Hg (mean (SD)); p<0.001) with one procedure related death (3.2%). Renal function deteriorated without TIPS but improved (p<0.001) within two weeks after TIPS (creatinine clearance 18 (15) to 48 (42) ml/min; sodium excretion 9 (16) to 77 (78) mmol/24 hours) and stabilised thereafter. Following TIPS, three, six, 12, and 18 month survival rates were 81%, 71%, 48%, and 35%, respectively. As only 10% of non-shunted patients survived three months, total survival rates were 63%, 56%, 39%, and 29%, respectively. Multivariate Cox regression analysis revealed bilirubin (p<0.001) and HRS type (p<0.05) as independent survival predictors after TIPS.

CONCLUSIONS TIPS provides long term renal function and probably survival benefits in the majority of non-transplantable cirrhotics with HRS. These data warrant controlled trials evaluating TIPS in the management of HRS.

  • hepatorenal syndrome
  • transjugular intrahepatic portosystemic stent-shunt
  • liver cirrhosis
  • portal hypertension
  • ascites
  • renal failure
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Footnotes

  • Abbreviations used in this paper:
    TIPS
    transjugular intrahepatic portosystemic stent-shunt
    HRS
    hepatorenal syndrome
    GFR
    glomerular filtration rates
    ET-1
    endothelin 1
    PRA
    plasma renin activity
    AR
    active renin

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