{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T20:28:25Z","timestamp":1774124905760,"version":"3.50.1"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":4079,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2004,7]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>Hepatorenal syndrome (HRS) is a functional renal disorder complicating decompensated cirrhosis. Treatments to date, except liver transplantation, have been able to improve but not normalize renal function. The aim of this study was to determine the efficacy of transjugular intrahepatic portosystemic stent shunt (TIPS) as a treatment for type 1 HRS in ascitic cirrhotic patients, following improvement in systemic hemodynamics with a combination of midodrine, octreotide, and albumin (medical treatment). Fourteen ascitic cirrhotic patients with type 1 HRS received medical therapy until their serum creatinine reached below 135 \u03bcmol\/L for at least 3 days, followed by a TIPS if there were no contraindications. Patients were assessed before and after medical treatment, as well as at 1 week and 1, 3, 6, and 12 months post-TIPS with measurements of renal function, sodium handling, systemic hemodynamics, central blood volume, and hormonal markers. Medical therapy for 14 \u00b1 3 days improved renal function (serum creatinine: 233 \u00b1 29 \u03bcmol\/L vs. 112 \u00b1 8 \u03bcmol\/L, <jats:italic toggle=\"yes\">P<\/jats:italic> = .001) and renal sodium excretion (5 \u00b1 2 mmol\/d vs. 9 \u00b1 2 mmol\/d, <jats:italic toggle=\"yes\">P<\/jats:italic> = .002) in 10 of the 14 patients. TIPS insertion in five of the responders further improved renal function and sodium excretion, so that by 12 months post-TIPS, glomerular filtration rate (96 \u00b1 20 mL\/min, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; .01 vs. pre-TIPS) and urinary sodium excretion (119 \u00b1 15 mmol\/d, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; .01 vs. pre-TIPS) were normal, associated with normalization of plasma renin and aldosterone levels and elimination of ascites. <jats:underline>In conclusion<\/jats:underline>, TIPS is an effective treatment for type 1 HRS in suitable patients with cirrhosis and ascites, following the improvement of renal function with combination therapy of midodrine, octreotide, and albumin. 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