title: Correlation between portal/hepatic vein gradient and response to transjugular intrahepatic portosystemic shunt creation in refractory ascites.
abstract: OBJECTIVE
  Transjugular portosystemic shunt (TIPS) creation is widely used in the treatment of patients with refractory ascites caused by portal hypertension. Although it is well-established that an optimal portosystemic gradient (PSG) to prevent recurrent variceal bleeding should be lower than 12 mm Hg, there are no clear data on the correlation between the post-TIPS portal/hepatic vein gradient (PHG) and control of ascites. The purpose of the present study was to determine whether there was any correlation between PHG and control of ascites after TIPS creation.
  
  
  METHODS
  Portal/hepatic vein gradients before and after TIPS creation were studied in 28 patients who underwent TIPS creation. A multivariate analysis was performed to determine whether the portal/hepatic vein gradient independently predicted response to TIPS. Patients were considered responders if ascites disappeared or there was no further need for paracentesis. Patients were considered nonresponders if they required repeat paracentesis one or more months after TIPS creation.
  
  
  RESULTS
  Among patients who experienced a response, the mean pre-TIPS PHG was significantly higher than that in those who did not respond (20.9 mm Hg +/- 5.1 vs 15 mm Hg +/- 3.4; P = .002). A higher pre-TIPS PHG was predictive of better response independent of severity of liver disease and serum creatinine level (odds ratio, 2.45; 95% CI, 1.23-4.9; P = 0.011).
  
  
  CONCLUSIONS
  If the findings established in this study are confirmed in prospective long-term studies, a pre-TIPS PHG measurement can be a useful tool in helping clinicians assess the potential benefit of TIPS in refractory ascites.
authors.affiliation: Department of Gastroenterology and Hepatology, Ochsner Foundation Hospital, BH 309, 1514 Jefferson Highway, New Orleans, Louisiana 70121, USA. snair@ochsner.org
authors.forename: Satheesh
authors.initials: S
authors.lastname: Nair
authors.forename: Ranvir
authors.initials: R
authors.lastname: Singh
authors.forename: Moises
authors.initials: M
authors.lastname: Yoselewitz
mesh_terms: D001201:Ascites / Q000209:etiology / Q000601:surgery*; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015607:Stents; D016896:Treatment Outcome