Transjugular Intrahepatic Portosystemic Shunt in Patients Who Have Undergone Liver Transplantation

Amesur, Nikhil B.; Zajko, Albert B.; Orons, Philip D.; Sammon, John K.; Casavilla, F

doi:10.1016/s1051-0443(99)70085-0

Cited by 38 publications

(28 citation statements)

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“…8 In this group, with a mean follow-up of 7.4 Ϯ 13.1 months, 4 patients died, 5 required retransplantation, and only 3 were stable following the TIPS. Amesur et al concluded that liver transplant recipients who have received a TIPS should be at high status for retransplantation.…”

Section: Commentsmentioning

confidence: 85%

“…Amesur et al 8 reported on 12 adult patients at 6 to 13 years after liver transplantation who received a TIPS for variceal bleeding or intractable ascites. 8 In this group, with a mean follow-up of 7.4 Ϯ 13.1 months, 4 patients died, 5 required retransplantation, and only 3 were stable following the TIPS.…”

Section: Commentsmentioning

confidence: 99%

“…Dawwas et al 8 assessed the effect of recipient serum sodium levels on the posttransplant survival of 5152 patients with chronic liver disease receiving liver transplants between March 1994 and March 2005 in the United Kingdom and Ireland. Compared with recipients having normal sodium levels (135-145 mEq/L, n ϭ 3066), recipients with severe hyponatremia (sodium Ͻ 130 mEq/L, n ϭ 541) had a higher risk-adjusted mortality in the first 90 days (hazard ratio, 1.55; 95% confidence interval, 1.18-2.04).…”

Section: Commentsmentioning

confidence: 99%

“…After implantation of a TIPS, the portal pressure gradient of 26 mm Hg decreased to 13 mm Hg. The ascites resolved in 10 days, the varices improved, and the liver function tests normalized.Amesur et al 8 reported on 12 adult patients at 6 to 13 years after liver transplantation who received a TIPS for variceal bleeding or intractable ascites.8 In this group, with a mean follow-up of 7.4 Ϯ 13.1 months, 4 patients died, 5 required retransplantation, and only 3 were stable following the TIPS. Amesur et al concluded that liver transplant recipients who have received a TIPS should be at high status for retransplantation.…”

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confidence: 99%

“…Amesur et al 8 reported on 12 adult patients at 6 to 13 years after liver transplantation who received a TIPS for variceal bleeding or intractable ascites.…”

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Use of transjugular intrahepatic portosystemic shunts after liver transplantation

Perkins

2009

Liver Transpl

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Background: Transjugular intrahepatic portosystemic shunts (TIPS) have been used to control symptomatic portal hypertension in patients awaiting liver transplant. Although their role in pretransplantation patients is well established, their role in posttransplantation patients is unclear. Study Design: Retrospective analyses were performed for 18 liver-transplant recipients who underwent TIPS for recurrent end-stage liver disease. Patients were evaluated in regard to gender, age, diagnoses, allograft type, indication for TIPS, portal pressures, laboratory results, Model for End-Stage Liver Disease (MELD) score, and outcomes. Results: Median days from transplant to TIPS was 939 days (range, 122 to 3,415 days). Indications included variceal bleeding (n ϭ 2) and ascites (n ϭ 16). Ten patients (56%) responded to TIPS; TIPS prevented bleeding in both patients with varices, and it achieved symptomatic benefit in half of all patients with ascites. TIPS reduced median portal pressures from 22 mmHg (range, 17 to 50 mmHg) to 16 mmHg (range, 11 to 22 mmHg) and median portosystemic pressure gradients from 18 mmHg (range, 8 to 30 mmHg) to 8 mmHg (range, 2 to 12 mmHg). It increased median Model for End-Stage Liver Disease scores from 16 (range, 12 to 29) to 17 (range, 10 to 34) immediately and to 22 (range, 10 to 35) at 1 month. Six patients (33%) underwent retransplantation at a median of 58 days (range, 21 to 71 days) post-TIPS. Of the remaining 12 patients, 3 (25%) were alive and well at a median of 90 days (range, 78 to 1,169 days) post-TIPS; 9 (75%) died at a median of 99 days (range, 13 to 1,400 days) post-TIPS. Subgroup analysis failed to demonstrate significant differences between patients whose ascites responded to TIPS (n ϭ 8) and patients whose ascites did not (n ϭ 8). Responders were younger, had higher baseline portal pressures, greater reductions in portal-systemic pressure gradients, and better hepatic function. Conclusions: Though small, this was the largest series to date of TIPS in liver-transplant recipients. Overall, 56% of patients responded to TIPS. No single factor predicted response or nonresponse of ascites to TIPS. Without retransplantation, 75% of patients died. Careful selection is necessary when considering TIPS for patients with ascites. COMMENTSAs the authors of this review point out, the transjugular intrahepatic portosystemic shunt (TIPS) is a well-established treatment for patients with end-stage liver disease prior to transplantation.1 Experience has been steadily accumulating for the use of TIPS after liver transplantation.The role of TIPS in treating veno-occlusive disease after liver transplantation was discussed earlier in a Liver Transplantation Worldwide column 2 reviewing a report by Senzolo et al.3 on the use of TIPS to treat 2 posttransplant patients with veno-occlusive disease, 1 of whom had complete resolution. TIPS has been placed in living donor left lateral segments. 4 TIPS has also been used to treat small-for-size syndrome after right lobe adult split liver transplan...

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Section: Commentsmentioning

confidence: 85%

Section: Commentsmentioning

confidence: 99%

Section: Commentsmentioning

confidence: 99%

mentioning

confidence: 99%

“…Amesur et al 8 reported on 12 adult patients at 6 to 13 years after liver transplantation who received a TIPS for variceal bleeding or intractable ascites.…”

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Use of transjugular intrahepatic portosystemic shunts after liver transplantation

Perkins

2009

Liver Transpl

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A case-controlled study of the safety and efficacy of transjugular intrahepatic portosystemic shunts after liver transplantation

et al. 2011

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The role of transjugular intrahepatic portosystemic shunt (TIPS) insertion in managing the complications of portal hypertension is well established, but its utility in patients who have previously undergone liver transplantation is not well documented. Twentytwo orthotopic liver transplantation (OLT) patients and 44 nontransplant patients (matched controls) who underwent TIPS were analyzed. In the OLT patients, the TIPS procedure was performed at a median of 44.8 months (range ¼ 0.3-143 months) after transplantation. Eight (36.4%) had variceal bleeding, and 14 (63.6%) had refractory ascites. The underlying liver disease was cholestatic in 10 (45.4%) and viral in 4 (18.2%). The mean pre-TIPS Model for End-Stage Liver Disease (MELD) score was 13.4 6 5.1. There were no significant differences in age, sex, indication, etiology, or MELD score with respect to the control group. The mean initial portal pressure gradients (PPGs) were similar in the 2 groups (21.0 versus 22.4 mm Hg for the OLT patients and controls, respectively), but the final PPG was lower in the control group (9.9 versus 6.9 mm Hg, P < 0.05). The rates of both technical success and clinical success were higher in the control group versus the OLT group [95.5% versus 68.2% (P < 0.05) and 93.2% versus 77.2% (P < 0.05), respectively]. The rates of complications and post-TIPS encephalopathy were similar in the 2 groups, and there was a trend toward increased rates of shunt insufficiency in the OLT group. The mortality rate of the patients with a pre-TIPS MELD score > 15 was significantly higher in the OLT group [hazard ratio (HR) ¼ 4.32, 95% confidence interval (CI) ¼ 1.45-12.88, P < 0.05], but the mortality rates of the patients with a pre-TIPS MELD score < 15 were similar in the 2 groups. In the OLT group, the predictors of increased mortality were the pre-TIPS MELD score (HR ¼ 1.161, 95% CI ¼ 1.036-1.305, P < 0.05) and pre-TIPS MELD scores > 15 (HR ¼ 5.846, 95% CI ¼ 1.754-19.485, P < 0.05). In conclusion, TIPS insertion is feasible in transplant recipients, although its efficacy is lower in these patients versus control patients. Outcomes are poor for OLT recipients with a pre-TIPS MELD score > 15.

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Transjugular intrahepatic portosystemic shunts in liver transplant recipients

2013

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The insertion of a transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure used to relieve the signs and symptoms of portal hypertension in patients with liver disease. The most common indications for placement are refractory ascites and variceal hemorrhage. In properly selected candidates, TIPS placement can serve as a bridge to liver transplantation. Expertise in TIPS placement after transplantation has significantly increased, which has allowed the procedure to become a viable option for retransplant candidates suffering the consequences of recurrent portal hypertension due to portal vein thrombosis, recurrent liver disease, or hepatic venous outflow obstruction (HVOO). However, TIPSs in liver transplant recipients are associated with a lower clinical response rate and a higher rate of complications in comparison with patients with native liver disease, and they are, therefore, generally reserved for patients with a Model for End‐Stage Liver Disease (MELD) score ≤ 15 and ≤ 12 in patients with HCV. The role of TIPS placement in nonliver transplant recipients has been well studied in large trials, and it translates well into clinical applicability to candidates for orthotopic liver transplantation (OLT). However, the experience with OLT recipients is heterogeneous and restricted to small series. Thus, we focus here on reviewing the current literature and discussing the proper use of TIPSs in liver transplant recipients. Liver Transpl 20:130‐139, 2014. © 2013 AASLD.

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Transjugular Intrahepatic Portosystemic Shunt in Patients Who Have Undergone Liver Transplantation

Cited by 38 publications

References 13 publications

Use of transjugular intrahepatic portosystemic shunts after liver transplantation

Use of transjugular intrahepatic portosystemic shunts after liver transplantation

A case-controlled study of the safety and efficacy of transjugular intrahepatic portosystemic shunts after liver transplantation

Transjugular intrahepatic portosystemic shunts in liver transplant recipients

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