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. 2021 Dec;41(12):2965-2973.
doi: 10.1111/liv.15060. Epub 2021 Sep 28.

The improvement in body composition including subcutaneous and visceral fat reduces ammonia and hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Stefania Gioia  1 , Lorenzo Ridola  1 , Ludovica Cristofaro  1 , Manuela Merli  1 , Jessica Faccioli  1 , Oliviero Riggio  1 , Silvia Nardelli  1
Affiliations

The improvement in body composition including subcutaneous and visceral fat reduces ammonia and hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Stefania Gioia et al. Liver Int. 2021 Dec.

Abstract

Background: Sarcopenia and myosteatosis have been associated to a poor prognosis of cirrhosis and to a higher incidence of hepatic encephalopathy (HE). The prognostic implications of visceral and subcutaneous adiposity are less known.

Aim: To evaluate the modifications of visceral and subcutaneous adipose tissue after TIPS and to investigate their relationships with the modification of muscle mass and with the incidence of post-TIPS HE.

Patients and methods: 35 cirrhotic patients submitted to TIPS were retrospectively studied. The modification of skeletal muscle index (SMI), muscle attenuation (myosteatosis), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), assessed by CT-scan and plasma ammonia were evaluated before and after a mean follow-up of 19 ± 15 months after TIPS. The number of episodes of overt HE was also recorded.

Results: During the follow-up, the mean SMI and muscle attenuation increased significantly; SATI significantly increased while VATI significantly decreased, although not uniformly in all patients. By comparing the patients with or without improvement in their nutritional status after TIPS, MELD remained stable while the number of episodes of overt HE was significantly lower in the patients with improved SMI and in the patients with improved SATI. Finally, inverse correlation was observed between the variation of ammonia and SATI (r = -.40; P < .05).

Conclusion: In addition to muscle mass, adipose tissue is modified after TIPS. The improvement of subcutaneous adipose tissue as well as of sarcopenia and myosteatosis is associated to the amelioration of cognitive impairment independently of liver function. The correlation between adipose tissue and ammonia modification may suggest an active role of the adipose tissue in the inter-organ ammonia trafficking.

Keywords: TIPS; adipose tissue; ammonia; hepatic encephalopathy; sarcopenia.

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Conflict of interest statement

The authors declare that no conflict of interest exists concerning this paper.

Figures

FIGURE 1
FIGURE 1
Patient flowchart
FIGURE 2
FIGURE 2
Comparison of the variations of SMI (Panel A), of SATI (Panel B) and of VATI (Panel C) before and after TIPS between the patients with or without ascites before TIPS placement
FIGURE 3
FIGURE 3
Correlation between muscle attenuation and subcutaneous adipose tissue index (SATI) before TIPS (Panel A) and correlation between muscle attenuation and visceral adipose tissue index (VATI) before TIPS in the 35 patients included in this study
FIGURE 4
FIGURE 4
Correlation between the variations of ammonia and skeletal muscle index (SMI) (Panel A) and correlation between the variations of ammonia and subcutaneous adipose tissue index (SATI) (Panel B) before and after transjugular intrahepatic portosystemic shunt in the 35 patients included in this study
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