Transjugular Intrahepatic Portosystemic Shunt Placement: Effects on Nutritional Status in Cirrhotic Patients

Abstract

Malnutrition is a tangible complication of cirrhosis with portal hypertension with a prevalence of up to 50%. In particular, sarcopenia and myosteatosis, defined as the alteration in muscle quantity and quality, have a negative impact on the main complications of liver disease and are associated with higher mortality in patients with cirrhosis. Recently, alterations in adipose tissue have also been described in cirrhotic patients and they seem to influence the course of liver disease. Several pieces of evidence indicate that a transjugular intrahepatic portosystemic shunt (TIPS), placed for the treatment of refractory portal hypertension, can lead to a modification of body composition consisting in the improvement of the skeletal muscle index, myosteatosis, and an increase in subcutaneous fat. These modifications of the nutritional status, even more pronounced in sarcopenic patients before TIPS, have been associated with an amelioration of cognitive impairment after TIPS as well as with an increase in the survival rate. The aim of this paper is to provide an overview of the effects of TIPS placement on nutritional status in cirrhosis focusing on its pathophysiological mechanisms and its relationship with liver-related outcomes.

Keywords: malnutrition; myosteatosis; portal hypertension; sarcopenia; transjugular intrahepatic portosystemic shunt.

Figure 1

Modifications of muscle mass and adipose tissue after TIPS placement. Contrast-enhanced abdominal CT scan of a 72 year old male cirrhotic patient submitted to TIPS for treatment of refractory ascites. Six months after TIPS placement, the skeletal muscle area (red) increased from 15,976 cm² to 19,266 cm² with an increase in SMI from 49.3 cm²/m² to 59.4 cm²/m²; parallelly, subcutaneous adipose tissue (SAT) (light blue) increased from 5649 cm² to 13,248 cm² with an increase in SATI from 17.4 cm²/m² to 40 cm²/m². Visceral adipose tissue (VAT) (yellow) decreased from 9202 cm² to 7809 cm² with a decrease in VATI from 28 cm²/m² to 24 cm²/m².