Transjugular intrahepatic porto-systemic shunt in cirrhotic patients with hepatorenal syndrome-chronic kidney disease: Impact on renal function

Background and aims: Transjugular intrahepatic porto-systemic shunt (TIPS) ameliorates renal function in type-2 hepatorenal syndrome (HRS). Available evidence is based on 'old' HRS diagnostic criteria, and not on the current definition of HRS - chronic kidney disease (HRS-CKD). Among patients who underwent TIPS for refractory ascites over the last 12 years, we investigated clinical and renal function evolution of those with HRS-CKD.Methods: among 212 patients, 41 with HRS-CKD were included. Renal function was evaluated for 12 months after TIPS, along with management of ascites and transplant-free survival (TFS).Results: renal function significantly improved already one week after TIPS [serum creatinine (sCr): 1.37 +/- 0.23 vs 1.94 +/- 0.54 mg/dl, p < 0.001]; the amelioration was maintained during the whole followup and was observed in every CKD stage, defined according to baseline estimated Glomerular Filtration Rate (eGFR). sCr and eGFR became comparable between different CKD stages after only one week, whilst significantly different at baseline. TIPS led to a remarkable improvement in the control of ascites in all CKD stages and no significant differences in TFS were recorded.Conclusions: TIPS led to an early, substantial and persistent improvement in renal function in patients with HRS-CKD, irrespective of their baseline CKD stage.(c) 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Automated summary

The study found that TIPS can significantly improve renal function in patients with HRS-CKD in the early postoperative period, and this improvement is maintained throughout the follow-up period. The improvement is observed in every CKD stage, and TIPS also improves the control of ascites significantly. There is no significant difference in transplant-free survival rate regardless of the baseline CKD stage.