title: Renal haemodynamics and function following partial portal decompression.
abstract: BACKGROUND
  This study was undertaken to prospectively evaluate the impact of partial portal decompression on renal haemodynamics and renal function in patients with cirrhosis and portal hypertension.
  
  
  METHODS
  Fifteen consecutive patients (median age 49 years) with cirrhosis underwent partial portal decompression through portacaval shunting or transjugular intrahepatic portosystemic shunting (TIPS). Cirrhosis was caused by alcohol in 47%, hepatitis C in 13%, both in 33% and autoimmune factors in 7% of patients. Child class was A in 13%, B in 20% and C in 67% of patients. The median score on the Model for End-stage Liver Disease (MELD) was 14.0 (mean 15.0 +/- 7.7). Serum creatinine (SrCr) and creatinine clearance (CrCl) were determined pre-shunt, 5 days after shunting and 1 year after shunting. Colour-flow Doppler ultrasound of the renal arteries was also undertaken with calculation of the resistive index (RI) and pulsatility index (PI). Changes in the portal vein-inferior vena cava pressure gradient with shunting were determined.
  
  
  RESULTS
  With shunting, the portal vein-inferior vena cava gradients dropped significantly, with significant increases in PI in the early period after shunting. Creatinine clearance improved in the early post-shunt period. However, SrCr levels did not significantly improve. At 1 year after shunting, both CrCl and SrCr levels tended towards pre-shunt levels and the increase in PI did not persist.
  
  
  CONCLUSIONS
  Partial portal decompression improves mild to moderate renal dysfunction in patients with cirrhosis. Early improvements in renal function after shunting begin to disappear by 1 year after shunting.
authors: Department of Surgery, University of South Florida, c/o Tampa General Hospital, Tampa, FL 33601, USA.
authors: Sharona
authors: S
authors: Ross
authors: Donald
authors: D
authors: Thometz
authors: Francesco
authors: F
authors: Serafini
authors: Mark
authors: M
authors: Bloomston
authors: Connor
authors: C
authors: Morton
authors: Emmanuel
authors: E
authors: Zervos
authors: Alexander
authors: A
authors: Rosemurgy