Peritoneovenous Shunt as a Bridge to Liver Transplantation

Dumortier, Jérôme; Pianta, E; Derf, Y Le; Bernard, Pierre; Bouffard, Y.; Boucaud, Catherine; Sagnard, Pierre; Delafosse, B.; Boillot, Olivier

doi:10.1111/j.1600-6143.2005.00959.x

Cited by 19 publications

(8 citation statements)

References 27 publications

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“…From our results, increased circulating blood volume due to PVS may induce effective renal blood flow and diuretic effect. Similar results are reported in cirrhotic patients with intractable ascites where GFR significantly improved after PVS placement during the waiting period before liver transplantation (14). Seike et al.…”

Section: Discussionsupporting

confidence: 85%

The influence of a peritoneovenous shunt for cirrhotic and malignant intractable ascites on renal function

Segawa

Kato

Kawashima

et al. 2018

Acta Radiologica Open

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BackgroundPeritoneovenous shunts (PVS) are widely used for palliation of intractable ascites caused by peritoneal carcinomatosis (PC) or liver cirrhosis (LC). Some patients who need PVS have renal dysfunction. However, renal dysfunction is considered a relative contraindication. Therefore, it is important to assess renal function before PVS placement.PurposeTo evaluate the relationship between PVS and renal function.Material and MethodsBetween October 2007 and July 2015, 60 patients (PC = 47; LC = 10; others = 3) underwent PVS placement for intractable ascites. Changes in estimated glomerular filtration rate (eGFR) and other adverse events (AEs) were retrospectively analyzed.ResultsChanges in eGFR before, one day after, and one week after PVS placement could be evaluated in 46 patients. The median eGFR before, one day after, and one week after was 56.5, 59.1, and 64.7 mL/min/1.73 m2, respectively (P < 0.05). These values were 61.6, 72, and 67.1 mL/min/1.73 m2, respectively, in PC patients (n = 34; P < 0.05) and 28.5, 27, and 37.2 mL/min/1.73 m2, respectively, in LC patients (n = 10; P < 0.05). In 17 patients with moderate to severe renal dysfunction (eGFR < 45), these values were 23.4, 23.7, and 30.5 mL/min/1.73 m2, respectively. The most frequent AE was PVS catheter obstruction, which occurred in 12 patients (20.7%). Clinical disseminated intravascular coagulation occurred in six patients (10.3%) and caused death in three patients (5.2%).ConclusionPVS placement for intractable ascites is associated with various AEs. However, PVS appeared to promote renal function, especially in patients with renal impairment.

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Section: Discussionsupporting

confidence: 85%

The influence of a peritoneovenous shunt for cirrhotic and malignant intractable ascites on renal function

Segawa

Kato

Kawashima

et al. 2018

Acta Radiologica Open

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“…However, its use has been almost abandoned (it is still used in some centres but experience is limited) due to severe side effects-shunt occlusion, vena cava thrombosis, peritoneal fibrosis-its limited long-term effectiveness, and the introduction of alternative therapies, such as therapeutic paracentesis. 35 The most studied non-pharmacological intervention for portal hypertension is the transjugular intrahepatic portosystemic shunt (TIPS). TIPS was introduced two decades ago as a treatment and alternative to shunt surgery for variceal bleeding in cirrhotic patients.…”

Section: Other Therapeutic Methodsmentioning

confidence: 99%

Management of ascites and hepatic hydrothorax

Cárdenas

Arroyo

2007

Best Practice & Research Clinical Gastroenterology

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“…Due to these complications, PVS has a limited role in the management ascites and may be considered when TIPS is contraindicated and as a bridge to liver transplantation. [28,29].…”

Section: Peritoneo-venous Shunt (Pvs Shunt)mentioning

confidence: 98%

Ascites in Children

Bavdekar¹,

Thakur²

2016

Indian J Pediatr

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Ascites is an accumulation of serous fluid within the peritoneal cavity. It is the most common complication of liver cirrhosis. In children, hepatic, renal and cardiac disorders are the most common causes. Portal hypertension and sodium and fluid retention are key factors in the pathophysiology of ascites. Peripheral arterial vasodilatation hypothesis is the most accepted mechanism for inappropriate sodium retention and formation of ascites. Diagnostic paracentesis is indicated in children with newly diagnosed ascites and in children with suspected complications of ascites. Ascitic fluid is evaluated for cell count, protein level, and culture. The serum-ascites albumin gradient (SAAG) is the best single test for classifying ascites into portal hypertensive (SAAG >1.1 g/dl) and non-portal hypertensive (SAAG <1.1 g/dl). A neutrophil count ≥250 cells/mm is highly suggestive of bacterial peritonitis. The treatment of ascites due to non-liver disease depends on the underlying condition. In liver disease, diuretics as monotherapy or dual therapy and salt restriction form the mainstay of treatment in children with mild to moderate ascites. Fluid restriction is helpful in children with hyponatremia. In non-responsive ascites or in children with large ascites, large volume paracentesis (LVP) with albumin infusion should be performed. In children with refractory ascites, LVP with albumin administration, transjugular intrahepatic porto-systemic shunt (TIPS), peritoneo-venous shunting and liver transplantation are other therapeutic modalities that need to be considered.

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Peritoneovenous Shunt as a Bridge to Liver Transplantation

Cited by 19 publications

References 27 publications

The influence of a peritoneovenous shunt for cirrhotic and malignant intractable ascites on renal function

The influence of a peritoneovenous shunt for cirrhotic and malignant intractable ascites on renal function

Management of ascites and hepatic hydrothorax

Ascites in Children

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