Tips for severe hepatorenal syndrome in non-transplant cirrhotics: a new option?!

TIPS FOR SEVERE HEPATORENAL SYNDROME IN NON-TRANSPLANT CIRRHOTICS: A NEW OPTION?! KA Brensin¢,. J Textorg*), J Perz, P Schiedermaifr, P Rash, H Strunk(*). FlU Klehr, HJ Kramer. U SDenaler. H Schild(*), T Sauerbruch, Depts. of Medicine & Radiology(*), University of Bonn, 53105 Bonn, Germany. Without urgent transplantation (LTx), only 10% of cirrhotics with hepatorenal syndrome (HRS) survive three months (l). Recent HRS data (2) suggest benefits after TIPS, but long-term data in non-transplant patients with severe HRS is missing. Method: We studied 16 non-transplantable Child-C cirrhotics with typed HRS (creatinine >2.5 mg/dl or GFR 12 Child-pts or bilirubin >15 mg/dl) were excluded and received best medical support. Patients were followed for at least 13 weeks (wks; median: 14; 0.2-120). We analysed renal function and survival (Kaplan-Meier). Results: Renal function (+SD) deteriorated without TIPS, but improved (p < 0.001) within 2 wks after TIPS (creatinine: 4.5+1.9 vs. 2.7+1.1 mg/dl; GFR: 9.0+9 vs. 29+ 24 ml/min; urine-Na: 7.1+7 vs. 54+51 mmol/24h). At 13 wks clearance was 45 ml/min and 4/5 patients were off hemodialysis. After TIPS, survival was 76% and 39% at 6 and 12 months (median: 48+5 wks), but only 12 % at 6 months without T! PS (median: 2+0.3 wks; p < 0.0001 vs. TIPS). Total cohort survival at 6 and 12 months was 55% and 19%. In multivariate analysis assignment to TIPS correlated independently to survival. Conclusions: About half of non-transplant cirrhotics with severe HRS may qualify for small TIPS. TIPS can improve renal function and provide favourable 6month survival, which may even offer the chanc~ for LTx reevaluation to some patients. (1) Gines et al. Gastroenterology 1993; 105: 229-236. (2) Brensing et al. Lancet 1997; 349: 697-698.