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Background and Aims <p>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.</p> Methods <p>We retrospectively analyzed cirrhotic patients with refractory ascites and HRS-NAKI treated with TIPS (<i>n</i> = 35) and those receiving standard medical therapy alone (<i>n</i> = 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&#xa0;months were recorded and comparisons were made between both groups using appropriate statistical tests.</p> Results <p>At six&#xa0;months, TIPS patients demonstrated improvement in serum creatinine (1.72 ± 0.31 to 1.41 ± 0.28&#xa0;mg/dL) and urea (78.6 ± 21.4 to 52.3 ± 18.9&#xa0;mg/dL), while controls showed deterioration. Urinary sodium increased significantly after TIPS (14.0 ± 6.9 to 55.5 ± 25.0&#xa0;mmol/L at three months, <i>p</i> = 0.001). Mean large-volume paracentesis frequency was lower in TIPS patients (0.52 vs. 1.16 per month, <i>p</i> = 0.002). Plasma renin activity declined after TIPS (13.9 ± 1.5 to 4.8 ± 1.2&#xa0;ng/mL/h at six&#xa0;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.</p> Conclusion <p>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.</p> Graphical Abstract <p></p>

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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

  • 期刊论文

  • 发表日期：

    2026年4月13日

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  • Abhinandan Kumar,
  • Amar Mukund,
  • Omkar Rudra,
  • Sushant Babbar,
  • Ranjan Kumar Patel,
  • Yashwant Patidar,
  • Ankur Jindal,
  • Shiv Kumar Sarin

摘要

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.

Graphical Abstract