***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Recent small studies on hepatorenal syndrome ( HRS ) indicate some clinical benefit after transjugular intrahepatic portosystemic stent-shunt ( TIPS ) but sufficient long term data are lacking . AIM We studied prospect ively feasibility , safety , and long term survival after TIPS in 41 non-transplantable cirrhotics with HRS ( phase II study ) . PATIENTS AND METHODS HRS was diagnosed using current criteria ( severe ( type I ) HRS , n=21 ; moderate ( type II ) HRS , n=20 ) . Thirty one patients ( 14 type I , 17 type II ) received  TIPS  ( 8–10 mm ) while advanced liver failure excluded shunting  in 10 . During follow up ( median 24 months ) we analysed renal function and survival ( Kaplan-Meier ) . RESULTS TIPS markedly reduced the portal pressure gradient ( 21 ( 5 ) to 13 ( 4 ) mm Hg ( mean ( SD ) ) ; p<0.001 ) with one procedure related death ( 3.2 % ) . Renal function deteriorated without TIPS but improved ( p<0.001 ) within two weeks after TIPS ( creatinine clearance 18 ( 15 ) to 48 ( 42 ) ml/min ; sodium excretion 9 ( 16 ) to 77 ( 78 ) mmol/24 hours ) and stabilised thereafter . Following TIPS , three , six , 12 , and 18 month survival rates were 81 % , 71 % , 48 % , and 35 % , respectively . As only 10 % of non-shunted patients survived three months , total survival rates were 63 % , 56 % , 39 % , and 29 % , respectively . Multivariate Cox regression analysis revealed bilirubin ( p<0.001 ) and HRS type ( p<0.05 ) as independent survival predictors after TIPS . CONCLUSIONS TIPS provides long term renal function and probably survival benefits in the majority of non-transplantable cirrhotics with HRS . These data warrant controlled trials evaluating TIPS in the management of HRS PURPOSE We aim ed to evaluate the effects of transjugular intrahepatic portosystemic stent shunt ( TIPS ) on systemic cardiocirculatory parameters in patients treated with TIPS for portal hypertension-associated complications . MATERIAL S AND METHODS This prospect i ve study was conducted in an intensive care unit of a German university hospital ( October 2010-July 2013 ) . We assessed hemodynamic parameters before and after TIPS placement using single-indicator transpulmonary thermodilution and pulse contour analysis . After exclusion of 5 patients treated with vasoactive agents during study measurements , 15 patients were included in the final statistical analysis . RESULTS Transjugular intrahepatic portosystemic stent shunt induced a statistically significant decrease in portal pressure ( median , 29 [ 25%-75 % percentile range , 23 - 37 ] mm Hg before TIPS vs 21 [ 18 - 27 ] mm Hg after TIPS ; P<.01 ) in parallel with a statistically significant increase in central venous pressure ( 10 [ 6 - 15 ] mm Hg before TIPS vs 13 [ 9 - 16 ] mm Hg after TIPS ; P=.01 ) , cardiac index ( 3.8 [ 2.9 - 4.6 ] L min(-1 ) m(-2 ) before TIPS vs 4.5 [ 3.8 - 5.4 ] L min(-1 ) m(-2 ) 14 hours after TIPS ; P=.01 ) , and stroke volume index ( 54 [ 42 - 60 ] mL/m2 before TIPS vs 60 [ 47 - 63 ] mL/m2 14 hours after TIPS ; P=.03 ) . Arterial blood pressure and systemic vascular resistance index were statistically significantly lower after TIPS . CONCLUSIONS Transjugular intrahepatic portosystemic stent shunt placement is associated with an increase in central venous pressure and an improvement of global blood flow ( cardiac index and stroke volume index ) in patients with portal hypertension BACKGROUND & AIMS Hepatorenal syndrome ( HRS ) type 1 is a progressive functional renal failure in subjects with advanced liver disease . The aim of this study was to evaluate the efficacy and safety of terlipressin , a systemic arterial vasoconstrictor , for cirrhosis type 1 HRS . METHODS A prospect i ve , r and omized , double-blind , placebo-controlled clinical trial of terlipressin was performed . Subjects with type 1 HRS were r and omized to terlipressin ( 1 mg intravenously every 6 hours ) or placebo plus albumin in both groups . The dose was doubled on day 4 if the serum creatinine ( SCr ) level did not decrease by 30 % of baseline . Treatment was continued to day 14 unless treatment success , death , dialysis , or transplantation occurred . Treatment success was defined by a decrease in SCr level to < /=1.5 mg/dL for at least 48 hours by day 14 without dialysis , death , or relapse of HRS type 1 . RESULTS Fifty-six subjects were r and omized to each arm .  Treatment success with terlipressin was double that with placebo ( 25 % vs 12.5 % , P = .093 ) . SCr level improved from baseline to day 14 on terlipressin ( -0.7 mg/dL ) as compared with placebo ( 0 mg/dL ) , P < .009 . Terlipressin was superior to placebo for HRS reversal ( 34 % vs 13 % , P = .008 ) , defined by decrease in SCr level < /=1.5 mg/dL. Overall and transplantation-free survival was similar between study groups ; HRS reversal significantly improved survival at day 180 . One nonfatal myocardial infa rct ion occurred with terlipressin , but the total adverse event rate was similar to placebo . CONCLUSIONS Terlipressin is an effective treatment to improve renal function in HRS type 1 In patients with cirrhosis and hepatorenal syndrome ( HRS ) , terlipressin has been used either as continuous intravenous infusion or as intravenous boluses . To date , these two approaches have never been compared . The goal of this study was to compare the administration of terlipressin as continuous intravenous infusion versus intravenous boluses in the treatment of type 1 HRS . Seventy‐eight patients were r and omly assigned to receive either continuous intravenous infusion ( TERLI‐INF group ) at the initial dose of 2 mg/day or intravenous boluses of terlipressin ( TERLI‐BOL group ) at the initial dose of 0.5 mg every 4 hours . In case of no response , the dose was progressively increased to a final dose of 12 mg/day in both groups . Albumin was given at the same dose in both groups ( 1 g/kg of body weight at the first day followed by 20‐40 g/day ) . Complete response was defined by decrease of serum creatinine ( sCr ) from baseline to a final value ≤133 μmol/L , partial response by a decrease ≥50 % of sCr from baseline to a final value > 133 μmol/L. The rate of adverse events was lower in the TERLI‐INF group ( 35.29 % ) than in the TERLI‐BOL group ( 62.16 % , P < 0.025 ) . The rate of response to treatment , including both complete and partial response , was not significantly different between the two groups ( 76.47 % versus 64.85 % ; P value not significant ) . The mean daily effective dose  of terlipressin was lower in the TERLI‐INF group than in the TERLI‐BOL group ( 2.23 ± 0.65 versus 3.51 ± 1.77 mg/day ; P < 0.05 ) . Conclusion : Terlipressin given by continuous intravenous infusion is better tolerated than intravenous boluses in the treatment of type 1 HRS . Moreover , it is effective at doses lower than those required for intravenous bolus administration . ( Hepatology 2016;63:983–992 Objectives Renal failure secondary to hepatorenal syndrome or to organic renal disease occurs frequently in cirrhotic patients with portal hypertension . The present prospect i ve study investigates the usefulness of terlipressin in both the diagnostic and the therapeutic approach to cirrhotics with renal failure . Patients and methods Sixteen patients were studied : 11 with hepatorenal syndrome type 2 ( group 1 ) and five with organic renal disease ( group 2 ) . All received terlipressin ( 1 mg/4 h intravenously ) for 7 days . Subsequently , 12 patients ( nine from group 1 and three from group 2 ) underwent a transjugular intrahepatic portosystemic shunt . Results Terlipressin significantly improved renal function ( serum creatinine , 1.8 ± 0.8 versus 2.4 ± 0.9 mg/dl ; blood creatinine clearance , 53 ± 8 versus 21.3 ± 8.7 ml/min ; P < 0.05 ) in group 1 [ 8/11 patients ( 73 % ) versus 1/5 ( 20 % ) of group 2 ; P < 0.05 ] . The only patient in group 2 who responded to terlipressin had a mixed renal dysfunction . Renal function improved significantly after transjugular portosystemic shunt in all patients who responded to terlipressin . Conclusions Terlipressin administration significantly improves renal function in cirrhotic patients with hepatorenal syndrome type 2 but not in organic kidney failure . By providing the critical information that a patient 's kidney function is ( or is not ) reversible , a trial with terlipressin may be useful when selecting cirrhotic patients with renal failure as c and i date s for a transjugular intrahepatic portosystemic shunt or liver transplantation BACKGROUND / AIMS TIPS ( transjugular intrahepatic portosystemic stent-shunt ) has been used increasingly in the management of refractory variceal bleeding .  Its role in the management of refractory ascites and hepatorenal syndrome still awaits further prospect i ve studies . Type-2 hepatorenal syndrome is a moderate steady renal impairment . It arises spontaneously and it is the main mechanism of refractory ascites . Precipitating factors may lead to type-1 hepatorenal syndrome . Hepatorenal syndrome is a common complication of advanced cirrhosis with a 3-month mortality of more than 90 % unless treated by orthotopic liver transplantation . However , because of the short survival of patients with hepatorenal syndrome and the limited availability of organs , only a small percentage of patients with hepatorenal syndrome can actually reach orthotopic liver transplantation . That is why awaiting orthotopic liver transplantation we have su bmi tted some suitable patients to a TIPS setting . METHODOLOGY We have considered eighteen consecutive patients affected by advanced cirrhosis ( Child-Pugh 10 - 12 ) awaiting orthotopic liver transplantation and suitable for TIPS treatment for the presence of type-2 hepatorenal syndrome ( 10 males , average age 44.5 ) . The criteria for the diagnosis of hepatorenal syndrome and refractory ascites have been effected according to a consensus recommendation . Organic kidney disease was excluded . After mild intravenous sedation and analgesia a puncture needle was advanced transjugular in a catheter through the inferior cava into one of the three hepatic veins . Subsequently , an intrahepatic branch of the portal vein was punctured and the shunt was established by the implantation of Wallstent ( diameter 10 mm ; Boston , Scientific , Natick , MA ) . In all patients , we compared serum creatinine , creatinine-clearance , sodium excretion and urine volume before the intervention and 12 weeks after TIPS . The differences among groups were analyzed using paired Student 's t-test . RESULTS The stent shunt was successfully established in all eighteen patients .  Complications occurred in 4 patients ( temperature above 38 degrees C or vomiting ) . No patients have developed hepatic encephalopathy resistant to medical treatment . As for the ascites a complete response with total remission of ascites was obtained in eight patients , while a partial response with the presence of sonographically detectable ascites -- without the need of paracentesis -- was obtained in ten patients . As regards renal functional parameters we have evidence d a significant improvement after TIPS . CONCLUSIONS We can notice how the setting of TIPS , at least in the presented case , has allowed the treatment of ascites and , furthermore , has lead to improvement of the renal functional parameters . It all implies the enormous advantage of a better management of the patient waiting for orthotopic liver transplantation  and , most of all , the advantage of preparing the patient for the surgical intervention with normal renal functional parameters : in fact , it is well known that the increase of serum creatinine influences the pre- and post-orthotopic liver transplantation course , and in particular can modify the mortality rate of the patient list . The lack of effective alternative treatment modalities and the almost universally fatal outcome of hepatorenal syndrome make TIPS an attractive option in the treatment of 
    Output:
    
After  transjugular intrahepatic portosystemic shunt , serum creatinine , blood urea nitrogen , serum sodium , sodium excretion , and urine volume were significantly improved ; by comparison , serum bilirubin slightly increased , but the difference was not statistically significant .
Limited evidence suggested a potential survival benefit of transjugular intrahepatic portosystemic shunt in patients with hepatorenal syndrome but with a high incidence of hepatic encephalopathy