Abstract | PURPOSE: 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. MATERIALS AND 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.
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Authors | Curtis L Anderson, Wael E A Saad, Sean D Kalagher, Steven Caldwell, Saher Sabri, Ulku C Turba, Alan H Matsumoto, John F Angle |
Journal | Journal of vascular and interventional radiology : JVIR
(J Vasc Interv Radiol)
Vol. 21
Issue 9
Pg. 1370-6
(Sep 2010)
ISSN: 1535-7732 [Electronic] United States |
PMID | 20691610
(Publication Type: Journal Article)
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Copyright | Copyright 2010 SIR. Published by Elsevier Inc. All rights reserved. |
Chemical References |
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Topics |
- Adult
- Aged
- Biomarkers
(blood)
- Creatinine
(blood)
- Female
- Glomerular Filtration Rate
- Humans
- Kidney
(physiopathology)
- Liver Diseases
(complications, diagnosis, physiopathology, surgery)
- Liver Function Tests
- Male
- Middle Aged
- Portasystemic Shunt, Transjugular Intrahepatic
(adverse effects)
- Recovery of Function
- Renal Insufficiency
(complications, diagnosis, physiopathology)
- Retrospective Studies
- Severity of Illness Index
- Time Factors
- Treatment Outcome
- Virginia
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