Transjugular Intrahepatic Portosystemic Shunts for Hepatorenal Syndrome: TIPping the Scales in Whose Favor?
- PDF / 498,201 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 7 Downloads / 220 Views
EDITORIAL
Transjugular Intrahepatic Portosystemic Shunts for Hepatorenal Syndrome: TIPping the Scales in Whose Favor? M. Asim Khokhar1 · James O’Beirne1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abbreviations TIPS Transjugular intrahepatic portosystemic shunt HRS Hepatorenal syndrome LT Liver transplant SIRS Systemic inflammatory response syndrome HE Hepatic encephalopathy Hepatorenal syndrome (HRS) is a life-threatening though potentially reversible complication of liver cirrhosis associated with high mortality. HRS usually occurs after a precipitating event such as bacterial infection that triggers severe circulatory dysfunction, inadequate cardiac output, and a proinflammatory state that substantially reduces renal perfusion [1]. Though the most successful treatment is liver transplantation (LT), this option is not applicable to the vast majority of HRS patients due to a lack of available organs and/or patient factors affecting candidacy. Hence, there is much interest in alternate therapies which could either reverse HRS or bridge a patient to successful LT. Traditionally, the development of HRS has been based on the peripheral arterial vasodilation theory whereby splanchnic and peripheral vasodilation activated endogenous vasoconstrictors, progressing to renal vasoconstriction and ultimately HRS [2]. Accordingly, the application of vasoconstrictor therapy with volume expansion to address these circulatory changes has been adopted as rational treatment for the condition. Of the available therapies, the combination of octreotide, midodrine, and albumin is recommended in the USA, whereas the combination of terlipressin and * James O’Beirne [email protected]; [email protected] 1
Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, QLD, Australia
Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast (USC), 90 Sippy Downs Dr, Sippy Downs, QLD, Australia
2
albumin has gained wider acceptance worldwide and is recommended by European guidelines. Encouragingly, a trend toward reduced inpatient mortality and improved survival in HRS has been observed over last two decades according to the National Inpatient Database-based retrospective cohort studies [3, 4]. Nevertheless, in a recent meta-analysis of randomized controlled trials of different vasoconstrictor therapies, the pooled survival rate was only 23.8–37.7% despite a HRS reversal rate of 42.8%. Notably, there was no improvement in outcomes over the decade of study [5]. Clearly, currently available pharmacological therapies reveal an unmet need in the treatment of HRS. Given that the pathogenesis of circulatory dysfunction in HRS is dependent on the presence of portal hypertension, it is perhaps unsurprising that TIPS has been explored for this indication. Despite some encouraging case reports and pilot studies reporting reversal of HRS and prolonged survival, the lack of controlled data and difficulties in providing T
Data Loading...
