Overview

The hypothesis is that in patients with cirrhosis and refractory ascites candidate to TIPS, and sarcopenia (identified by a PMA ≤16 cm² at the level of L3), who are at high-risk of 6-month mortality after TIPS placement, a post-TIPS 12 weeks nutritional intervention is associated with improved post-TIPS prognosis.

The primary objective is to evaluate the effect of a post-TIPS 12 weeks nutritional intervention on liver transplant-free six-month survival in sarcopenic candidates to TIPS for refractory ascites in cirrhosis.

Eligibility

Inclusion Criteria:

• men and women with an age ≥ 18 and ≤ 80 years
• clinical, radiological or histological diagnosis of liver cirrhosis
• diagnosis of RA
• confirmation of sarcopenia defined in CT scan as the sum of the psoas muscle areas measured at the level of the 3rd lumbar vertebra (PMA) ≤16 cm2
• informed consent signed

Exclusion Criteria:

• severe hepatic insufficiency (bilirubin> 5 mg/dl, MELD score> 18, Child-Pugh score> 9)
• Congestive heart failure class ≥2 according to New York Heart Association criteria (NYHA)
• Active coronary heart disease (myocardial infarction within 6 months of the study)
• Severe pulmonary hypertension suspected on echocardiogram (systolic pulmonary arterial pressure [PAPs]> 35 mmHg) and confirmed with right cardiac catheterization (PAPs> 45mmHg)
• Chronic renal failure (creatinine> 3 mg/dl)
• Performance status ≥2 according to the Eastern Cooperative Oncology Group scale (ECOG)
• History of grade III-IV hepatic encephalopathy or West Haven grade I-II hepatic encephalopathy episodes within the last 3 months
• Uncontrolled systemic sepsis
• Presence of Hepatocellular carcinoma
• Complete portal vein thrombosis
• Active bleeding from gastroesophageal varices. Patients with adequately treated gastroesophageal varices can be included in the study (banding ligation, sclerotherapy)
• Diagnosis of extra hepatic neoplasia
• Transplant recipients
• Patients unable or unwilling to comply with the protocol requirements
• Pregnant or lactating women
• Patients unable to autonomously express their consent (incapable patients)
• any other laboratory condition or result that in the opinion of the Principal Investigator, preclude the subject's participation in the study