Renal Function Improvement after TIPS: Clinical evidence and biomarkers

作者：S Geißelbrecht, Christian Niehaus, A Tiede, H Rieland, J B Mauz, B Bremer, Julian Witt, M A Kabelitz, C Labenz, E M Schleicher, S J Gairing, M Cornberg, Anke Kraft, B C Meyer, C S Falk, H H Wedemeyer, B Maasoumy · 发表于：Zeitschrift für Gastroenterologie · 年份：2026 · DOI：10.1055/s-0045-1814271 · 研究领域：Chronic Kidney Disease and Diabetes、Renal and Vascular Pathologies、Acute Kidney Injury Research

Background and Aims Transjugular intrahepatic portosystemic shunt (TIPS) insertion can improve both renal function and systemic inflammation in patients with cirrhosis. However, serum creatinine (Cr) is an imperfect marker of renal function, as it is influenced by cirrhosis-related factors such as reduced muscle mass, malnutrition, and frailty. This study evaluated the utility of biomarkers for outcome prediction after TIPS and assessed whether neutrophil gelatinase–associated lipocalin (NGAL) can serve as both a marker of renal injury and systemic inflammation following TIPS. Method A total of 246 consecutive patients with decompensated cirrhosis who underwent TIPS insertion between 08/2019 and 04/2025 at Hannover and Mainz were prospectively enrolled. Structured follow-ups were conducted before TIPS and at 1, 6, 12, and 24 months post-TIPS to collect Cr values. Plasma NGAL levels were measured by ELISA. Longitudinal changes in Cr, NGAL and cytokines were analysed using linear mixed-effects models. Competing risk analyses evaluated survival and acute kidney injury (AKI) within 2 years after TIPS. Results Overall, patients (median age: 60, MELD 3.0: 15, 53% alcohol-related cirrhosis, 68% TIPS for refractory ascites) showed improved Cr (p<0.001) and NGAL (p=0.048). Patients with impaired renal function benefited the most. Baseline NGAL correlated with IL-6 (r=0.21) and predicted both death and AKI. Conclusion TIPS improved renal function and biomarker profiles, reflecting reve...