Short‐term effects of transjugular intrahepatic portosystemic shunt (TIPS) on functional liver plasma flow in patients with advanced cirrhosis

Abstract

— Aims/Background: TIPS, an effective procedure applied for the treatment of complications of portal hypertension, is potentially followed by worsening of the hyperdynamic circulation of cirrhosis and the impairment of liver function. The aim of the present study was to evaluate short‐term changes of functional liver plasma flow after application of TIPS, using the hepatic (extrarenal) clearance of D‐sorbitol (S‐HCl). Methods: Twenty‐five cirrhotic patients submitted to TIPS for prevention of variceal rebleeding entered the study. At steady‐state, during constant infusion of a solution of D‐sorbitol (25 mg/min), appropriate blood and urine samples were collected in order to calculate S‐HCl before and 120 min after TIPS opening. In addition, the hepatic extraction ratio of D‐sorbitol was directly measured at the level of the right (Er), where TIPS was applied, and of the left (El) hepatic veins; meanwhile the portocaval gradient (PCG) was registered, before and after stent dilation. A comparison of values obtained before and after TIPS application was performed by Student's t‐test for paired data. Results: After application of TIPS, a substantial reduction was observed in PCG (12.1 ± 4.2 vs 24.8 ± 4.3 mmHg; p<0.001) and Er values (20.6 ± 14.8 vs 57.5 ± 22.3%; p<0.001) but not El values (47.4 ± 22.0 vs 53.4 ± 21.4%; p=0.178). S‐HCl measured 120 min after TIPS opening was not statistically different from pre‐TIPS values (389.2 ± 212.1 vs 394.6 ± 152.7 ml/min; p=0.892), although S‐HCl variations in Child‐Pugh class B patients were positively correlated with portal pressure variations (r=0.63, p=0.016). Conclusion: Our results demonstrate that in patients with advanced cirrhosis, TIPS procedure, while effective in reducing portal hypertension, does not lead to alterations in the functional liver plasma flow within the first 2 h.

Long‐term results of balloon‐occluded retrograde transvenous obliteration for gastric fundal varices: Hepatic deterioration links to portosystemic shunt syndrome

“…There has not been a consensus on the effects of TIPS on hepatic function from decreasing the portal blood pressure and the portal blood flow. There are reports that TIPS does not change [29][30][31][32] or that it worsens 33,34 the liver function, but there is no report stating that TIPS improves the liver function. In studies on a hepatic cellular level, TIPS was reported to decrease ICGCli.…”