Safety and efficacy of trans-jugular intrahepatic portosystemic shunt in patient with liver cirrhosis with hepatorenal syndrome non-acute kidney injury and refractory ascites-A retrospective analysis.

Abstract

Background and aims: To evaluate the efficacy of trans-jugular intrahepatic portosystemic shunt (TIPS) in patients with liver cirrhosis with hepatorenal syndrome non-acute kidney injury (HRS-NAKI) and refractory ascites who are not candidates for liver transplantation.

Methods: We retrospectively analyzed cirrhotic patients with refractory ascites and HRS-NAKI treated with TIPS (n = 35) and those receiving standard medical therapy alone (n = 134). Propensity score matching (1:1) was performed using age, sex, model for end-stage liver disease (MELD) score, Child-Turcotte-Pugh (CTP) score, serum bilirubin, serum creatinine, serum sodium and ascites severity, yielding 35 matched controls. Laboratory and clinical parameters at one, three and six months were recorded and comparisons were made between both groups using appropriate statistical tests.

Results: At six months, TIPS patients demonstrated improvement in serum creatinine (1.72 ± 0.31 to 1.41 ± 0.28 mg/dL) and urea (78.6 ± 21.4 to 52.3 ± 18.9 mg/dL), while controls showed deterioration. Urinary sodium increased significantly after TIPS (14.0 ± 6.9 to 55.5 ± 25.0 mmol/L at three months, p = 0.001). Mean large-volume paracentesis frequency was lower in TIPS patients (0.52 vs. 1.16 per month, p = 0.002). Plasma renin activity declined after TIPS (13.9 ± 1.5 to 4.8 ± 1.2 ng/mL/h at six months). Hepatic encephalopathy occurred in 35.1%, liver failure in 5.7% and heart failure in 5.7%. Six-month mortality was 11.4% in the TIPS group and 20% in the control.

Conclusion: TIPS improves renal function, neuro-hormonal activation and ascites control in patients with HRS-NAKI and refractory ascites who are not transplant candidates. However, it is associated with significant adverse events including hepatic encephalopathy, liver failure and cardiac decompensation. Larger prospective studies are required to identify patients who derive maximal benefit.