Effect of transjugular intrahepatic portosystemic shunt placement on renal function: a 7-year, single-center experience.
OBJECTIVE
Transjugular intrahepatic portosystemic shunt (TIPS) creation has been shown to improve renal function in small series of patients with hepatorenal syndrome. The present study examined the effect of TIPS creation on renal function in a large series of patients undergoing TIPS creation who had varying degrees of baseline renal function.


METHODS
All de novo TIPS creations during a 7-year period at a single institution were retrospectively reviewed regardless of indication. Pre- and postprocedural laboratory values were obtained and used to calculate Model for End-Stage Liver Disease (MELD) scores and glomerular filtration rates. Subanalysis was performed based on degree of renal insufficiency and indication for the procedure.


RESULTS
A total of 201 successful conventional TIPS procedures were identified. Of those, 72 patients were excluded for lack of follow-up, death during the same hospitalization, lack of TIPS function, or end-stage renal failure requiring dialysis before TIPS creation, leaving 129 procedures. Patients with preprocedural creatinine levels of 1.2-1.9 mg/dL (n = 45) showed an improvement in mean creatinine from 1.5 to 1.1 mg/dL (P < 10(-12)) and patients with preprocedure creatinine levels greater than 2.0 mg/dL (n = 21) showed an improvement from 2.8 to 1.5 mg/dL (P < 10(-5)). MELD scores decreased in patients with creatinine levels greater than 2.0 mg/dL from 22.1 to 19.2 (P < 0.005) but increased in all other patient groups. Amount of iodinated contrast medium administered did not affect creatinine level changes.


CONCLUSIONS
TIPS creation improves renal dysfunction in chronic liver disease. Patients with poorer renal function benefit the most from TIPS creation.
Anderson
Curtis L
CL
Division of Angiography, Interventional Radiology, and Special Procedures, Department of Radiology, University of Virginia Health System, Box 800170, 1215 Lee St., Charlottesville, VA 22908, USA.
Saad
Wael E A
WE
Kalagher
Sean D
SD
Caldwell
Steven
S
Sabri
Saher
S
Turba
Ulku C
UC
Matsumoto
Alan H
AH
Angle
John F
JF
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D020127:Recovery of Function; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014768:Virginia
D015415:Biomarkers; D003404:Creatinine