Cirrhosis is frequently complicated by ascites that may become resistant to diuretic therapy. Transjugular intrahepatic portosystemic shunts (TIPS) represent a new treatment for this debilitating condition. The aim of this study was to ascertain the clinical efficacy of TIPS, as well as its impact on renal function and on hormonal parameters. Five inpatients with refractory ascites were studied prospectively before TIPS, and 3 and 14 days after TIPS. After TIPS, ascites completely resolved or was minimal in all patients. Diuretics were discontinued in three subjects and decreased by at least 50% in two. One patient developed liver failure after TIPS and required liver transplantation; the others remained stable after a mean follow-up of 14 months. Mean urinary sodium excretion increased from 2.1 ± 0.6 mEq/ 24 hr before TIPS to 13.0 ± 4.3 mEq/24 hr 14 days after TIPS. Mean serum creatinine and glomerular filtration rate also tended to improve during the study period. With the exception of the patient who developed liver failure, plasma aldosterone concentration decreased from a mean of 126.0 ± 29.9 ng/dL to 22.8 ± 6.8 ng/dL (P = .04), and plasma renin activity decreased from a mean of 9.0 ± 3.0 μg/L/h to 0.9 ± 0.1 μg/L/h (P = .08). Additionally, 19 patients who underwent TIPS for refractory ascites outside of this protocol were followed prospectively for a mean of 282 days. Clinical improvement in ascites control was noted in 74%, and the mean dose of diuretics was decreased by more than 50%. Nonresponders more often had underlying renal disease. In conclusion, TIPS is an effective therapy for refractory ascites in most patients. TIPS improves renal function and in most patients reverses underlying hormonal derangements. TIPS may have an adverse effect on hepatic function, necessitating careful patient selection.
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Abbreviations: TIPS, transjugular intrahepatic portosystemic shunt; AST, aspartate transaminase; GFR, glomerular filtration rate; UCSF, University of California, San Francisco; PRA, plasma renin activity. From the Departments of 1Medicine and 2Radiology, University of California, San Francisco, CA. Received April 13, 1994; accepted October 7, 1994. These studies were carried out in the General Clinical Research Center, University of California, San Francisco, CA, with funds provided by the Division of Research Resources, National Institutes of Health, Bethesda, MD, 5 MO1 RR-00079, U.S. Public Health Service. Supported in part by National Institutes of Health, Bethesda, MD, Grant no. DK-26743 (Liver Center Core). Presented in part at Digestive Disease Week, Boston, MA, May 18, 1993. Address reprint requests to: Kenneth A. Somberg, MD, Liver Transplant Unit, M-896, Box 0780, University of California, San Francisco, San Francisco, CA 9414340780. Copyright © 1995 by the American Association for the Study of Liver Diseases. 0270-9139/95/2103-001653.00/0