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Re-Evaluating Transjugular Intrahepatic Portosystemic Shunt Candidacy for Patients with Kidney Disease.
Megan M Griffin1, Cary H Paine1, Sarah F Sanghavi1,2
1Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.
Kidney360
|September 26, 2025
Summary
Transjugular intrahepatic portosystemic shunt (TIPS) can improve kidney function in cirrhosis patients with ascites. However, careful patient selection is crucial to mitigate risks like hepatic encephalopathy, especially in advanced liver disease.
Area of Science:
- Hepatology
- Nephrology
- Interventional Radiology
Background:
- Cirrhosis leads to portal hypertension, causing splanchnic vasodilation and reduced effective arterial blood volume.
- This can precipitate hepatorenal syndrome, characterized by diuretic-resistant ascites, rising creatinine, and hyponatremia.
Purpose of the Study:
- To review the physiological changes following Transjugular intrahepatic portosystemic shunt (TIPS) placement.
- To advocate for an individualized approach to TIPS selection in patients with kidney disease.
Main Methods:
- Literature review discussing the pathophysiology of hepatorenal syndrome and the impact of TIPS.
- Analysis of risk stratification for TIPS, including limitations of the Model for End-Stage Liver Disease (MELD) score.
Main Results:
- TIPS can decrease ascites recurrence and improve renal function in patients with diuretic-resistant ascites.
- Increased risk of hepatic encephalopathy and liver ischemia post-TIPS correlates with liver disease severity.
Conclusions:
- The MELD score's reliance on serum creatinine may not accurately reflect risk in patients who could benefit from TIPS for renal improvement.
- An individualized assessment is recommended for selecting patients with kidney disease for TIPS procedures.
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