Changes in adipokines after transjugular intrahepatic porto-systemic shunt indicate an anabolic shift in metabolism

Abstract

Decompressing the portal hypertension by inserting a transjugular intrahepatic porto-systemic shunt (TIPS) in undernourished liver cirrhosis patients results in gains in body weight. It is important to understand whether this reflects an advantageous or unfavourable shift in nutrition status. This to some extent can be judged from the changes in the patients' adipokine patterns. We, therefore, examined the circulating levels of the most important adipokines before and after the TIPS procedure. Twenty-five liver cirrhosis patients were examined before TIPS insertion and followed for six months after the procedure. Their body composition was determined by the bioimpedance technique. The serum concentrations of adiponectin, retinol binding protein 4 (RBP4), and leptin were measured. The TIPS procedure induced a 12% increase in body cell mass (P=0.03) but did not change the body fat mass. At six months, serum adiponectin was increased by 60% (mean±SD, 10.7±6.1 vs. 16.9±8.9mg/L; P=0.001), serum RBP4 was decreased by 45% (28.6±20.0 vs. 16.3±9.6mg/L; P=0.01), and the leptin levels remained unchanged. The TIPS-related tissue build up was accompanied by increased adiponectin and decreased RBP4. Such changes are associated with an anabolic condition where the adipose tissue possesses residual capacity for energy storage. TIPS, therefore, can be considered to be nutritionally beneficial to cirrhosis patients.