Severe acute alcoholic hepatitis and hepatorenal syndrome: role of transjugular intrahepatic portosystemic stent shunt

Acute Alcoholic Hepatitis (AAH) is a syndrome of progressive inflammatory liver injury associated with long-term heavy intake of ethanol. Mild to moderate forms of AAH frequently respond to alcoholic abstinence, whereas severe AAH is characterized by a poor prognosis. Up to 40% of these patients die within 6 months upon symptoms onset. This high rate of mortality is due to different factors: liver failure, severe infections, and portal hypertension with variceal bleeding and hepatorenal syndrome (HRS). In AAH, HRS is a common complication that leads to the death of more than 90% of the patients within 3 months, unless they had been liver transplanted. Transjugular Intrahepatic Portosystemic Stent Shunt (TIPS) has been increasingly used in the management of portal hypertension and its complications, and, it might become a valuable option in patients with HRS awaiting LT. This study has taken into consideration 9 consecutive patients affected by severe AHH with HRS suitable for TIPS. We have determined serum creatinine, blood urea nitrogen, serum sodium, sodium urinary excretion and urine volume in all patients, before the intervention, 7 days and 30 days after TIPS. Seven patients were transplanted within 6 months. After TIPS, the renal function improved with significant reduction in serum creatinine and increase in urine volume. We can conclude that TIPS is a valuable option in patients with severe AAH complicated by HRS and are waiting for liver transplantation.