Direct measurement of post-prandial portal haemodynamics in cirrhotic patients with a transjugular intrahepatic portosystemic stent-shunt

Objective Portal haemodynamics vary in response to eating and other stimuli, but any increase in portal venous pressure (PVP) in cirrhotic patients may be a risk factor for variceal bleeding, We directly assessed postprandial splanchnic haemodynamics in cirrhotic patients with a transjugular intrahepatic portosystemic stent-shunt (TIPSS) in situ. Methods A thermodilution catheter was inserted via the patent TIPSS into the portal vein in 12 cirrhotic patients. PVP, portal venous flow (PVF) (thermodilution method), portal vascular resistance (PVR), porto-atrial pressure gradient (PPG), heart rate, mean arterial pressure (MAP) and right atrial pressure (RAP) were measured. A 505 kcal meal was given and all haemodynamic measurements were repeated at 15 min intervals for 60 min. Results Following the meal, there was a significant rise in PVP from 11.2 +/- 1,5 to 14.0 +/- 1.9 mmHg at 15 min, and 14.0 +/- 1,8 mmHg at 30 min (P < 0.001); in PPG from 9.5 +/- 1.4 to 12,7 +/- 2.2 mmHg at 15 min and 12,7 +/- 2.1 mmHg at 30 min (P < 0.005); and in PVF from 1110.2 +/- 141.1 to 1543.2 +/- 227.6 ml/min at 30 min (P < 0,01). PVR fell from 0.08 +/- 0.01 to 0.05 +/- 0.01 RU at 30 min (P < 0,05), Heart rate increased from 77 +/- 4.1 to 80.5 +/- 5.4 bpm at 15 min (P < 0,05), but MAP and RAP remained unchanged, Conclusion In cirrhotic patients with TIPSS, significant changes in portal haemodynamics occur at 15-30 min following a meal, with minimal effect on systemic haemodynamics, This model offers a new technique to directly assess the causes for and possible treatments of post-prandial splanchnic hyperaemia in cirrhosis. (C) 1998 Lippincott-Raven Publishers.