Body composition changes after transjugular intrahepatic portosystemic shunt in patients with cirrhosis

AIM: To investigate the effect of transjugular intrahepatic porto-systemic shunt (TIPS) on malnutrition in portal hypertensive cirrhotic patients. METHODS: Twenty-one patients with liver cirrhosis and clinical indications for TIPS insertion were investigated before and 1, 4, 12, 52 wk after TIPS. For each patient we assayed body composition parameters [dry lean mass, fat mass, total body water (TBW)], routine liver and kidney function tests, and free fatty acids (FFA). Glucose and insulin were measured for the calculation of the homeostasis model assessment insulin resistance (HOMA-IR); liver function was measured by the galactose elimination capacity (GEC); the severity of liver disease was graded by model for end-stage liver disease (MELD). RESULTS: Porto-systemic gradient decreased after TIPS (6.0 \ub1 2.1 mmHg vs 15.8 \ub1 4.8 mmHg, P < 0.001). Patients were divided in two groups according to initial body mass index. After TIPS, normal weight patients had an increase in dry lean mass (from 10.9 \ub1 5.9 kg to 12.7 \ub1 5.6 kg, P = 0.031) and TBW (from 34.5 \ub1 7.6 L to 40.2 \ub1 10.8 L, P = 0.007), as well as insulin (from 88.9 \ub1 49.2 pmol/L to 164.7 \ub1 107.0 pmol/L, P = 0.009) and HOMA-IR (from 3.36% \ub1 2.18% to 6.18% \ub1 4.82%, P = 0.023). In overweight patients only FFA increased significantly (from 0.59 \ub1 0.24 mmol/L to 0.93 \ub1 0.34 mmol/L, P = 0.023). CONCLUSION: TIPS procedure is effective in lowering portal pressure in patients with portal hypertension and improves body composition without significant changes in metabolic parameters