P.1.308: ACUTE ALCOHOLIC HEPATITIS IN CIRRHOSIS PATIENTS WITH HEPATORENAL SYNDROME TYPE I: ROLE OF TRANSJUGULAR PORTO-SYSTEMIC STENT SHUNT

Abstract

P.1.307 – Table 1. Endoscopic spectrum of ulcerative colitis with diverticulosis (UCD), segmental colitis associated with diverticulosis (SCAD), and acute uncomplicated diverticulitis (AUD) UCD (25 pts.) SCAD (129 pts) AUD (130 pts.) Endoscopic spectrum Mild Moderate Severe A B C D Mild Moderate Severe (8 pts.) (10 pts.) (7 pts.) (72 pts.) (36 pts.) (13 pts.) (8 pts.) (67 pts.) (42 pts.) (21 pts.) Diffuse inflammation 7 (87.5) 9 (90.0) 7 (100) – – – 8 (100) 1 (1.5) 1 (2.4) 7 (33.3) Inflammation of inter-diverticular mucosa 1 (12.5) 1 (10.0) – 71 (98.6) 34 (94.4) 11 (84.6) – 2 (3.0) 12 (28.6) 13 (61.9) Inflammation of peri-diverticular mucosa – – – 1 (1.4) 2 (5.6) 2 (15.4) – 64 (95.5) 29 (69.0) 1 (4.8) Data are given as number (percentage) of patients (pts.). tive pts (4 males, mean age 50) affected by AAH (HCV-RNA and HBV-DNA negative) and presenting type 1 HRS. 4 patients had refractory ascites before the development of HRS. All patients had AAH on cirrhosis. HRS and RA (non responders to common therapy) has been diagnosed according to International Ascites Club (1996). Patients were studied after a minimun of 7 days on a 40 mEq/die sodium diet and without diuretics. During this period of observation renal function continued to worsen despite the administration of plasma expanders and vasocostrictors: patients were submitted to TIPS (stent diameter 10 mm) after a written informed consent. In all patients we compared laboratory parameters before intervention and 4 weeks after TIPS. Results: All stents were successfully established, 4 patients presenting minor complications. Function parameters in the table. Before TIPS After TIPS Serum Creatinine (mg/dl) 5.1±0.8 1.6±0.7* Serum Sodium (mEq/L) 124±3 135±3 Sodium Excretion (mEq/L) 6.6±3 65.0±17* Urine Volume (ml/d) 250±4.1 1040±181* *Paired t-test p<0.001. 3-6 months after 4 patients were listed for liver transplantation (status 2A), 2 patients progressively recovery liver function with abstinence, 1 patient presented a abuse alcholic relapse. Conclusions: Even in presence of AAH TIPS allows a satisfactory treatment of functional renal impairment and it is a valid bridge to liver transplantation.