Transjugular Intrahepatic Portosystemic Shunt Approach and Local Thrombolysis for Treatment of Early Posttransplant Portal Vein Thrombosis

Abstract

Early portal vein thrombosis is a rare but severe posttransplant complication that may lead to graft and/or patient loss. Transjugular intrahepatic portosystemic shunting and local thrombolysis may represent an easy solution to this major complication of liver transplantation.

Transjugular Intrahepatic Portosystemic Shunt with Thrombectomy for the Treatment of Portal Vein Thrombosis After Liver Transplantation

“…While uncommon, PVT can be a severe complication after OLT and most commonly occurs early after transplantation related to surgical manipulation, abnormal venous reconstruction, and pre-existing PVT [9,16,17]. However, our cases of PVT occurred years after OLT without evidence of underlying hepatic fibrosis or cirrhosis.…”

“…However, most were performed via a transhepatic transcutaneous approach with local thrombolysis, which may expose the patient to a greater risk of bleeding and local complications. Only one case report of TIPS and angioplasty for PVT after OLT has been reported, and this was performed within 3 weeks of OLT [9]. Although this report utilized local thrombolytic therapy with TPA, mechanical thrombectomy was not part of the treatment protocol.…”

“…Portal vein thrombosis typically occurs within weeks after orthotopic liver transplantation (OLT) and is uncommon, with a reported incidence of 1.2% [8]. As a result, the optimal management, including anticoagulation, thrombectomy, and TIPS for PVT after OLT is also not well defined [9,10]. Mechanical recanalization of the portal venous system in patients after OLT can be technically difficult and the efficacy is unknown.…”

Transjugular Intrahepatic Portosystemic Shunt Placement in Liver Transplant Recipients: Experiences with Pediatric and Adult Patients

“…LaBerge et al [1] mentioned two liver transplant recipients who [6] reported one incidental case of TIPS creation in a transplanted liver in their series of 110 patients. Ciccarelli et al [7] reported a case of early portal vein thrombosis after liver transplantation treated by combining TIPS creation and thrombolysis. A series of pediatric TIPS placements included a liver transplant recipient [8].…”

Pharmacological thrombolysis in Budd Chiari syndrome: a single centre experience and review of the literature

“…Vena caval occlusions have been treated with combinations of local thrombolysis, balloon angioplasty and metallic stent(s) [13]. Local thrombolysis via the transjugular and transhepatic approach has been used successfully in early post-liver transplant portal vein thrombosis [24,25]. Blum et al [26] recently reported the successful placement of TIPS followed immediately by local low dose thrombolysis in seven cirrhotic patients with portal vein thrombosis, without complication.…”