Transjugular intrahepatic portosystemic shunting with covered stents in children: A preliminary study of safety and patency

Evaluation of transjugular intrahepatic portosystemic shunt (TIPS) as a previous step to liver transplantation in pediatric patients

“…The main reason for TIPS in our patients was the presence of hard-to-control ascites (70%), with esophageal variceal bleeding (EVB) being less prevalent (10%). These data significantly differ from the main indications in the series of pediatric patients undergoing TIPS published (4)(5)(6)(7)(8)(9)(10)(11)(12) , with EVB being the reason for TIPS in more than 80% of cases. It is worth noting that mean age in the various series published (6)(7)(8)11,12) is 11-12 years old, which means patients were remarkably older than ours, who were just 2 years old approximately.…”

“…There are no pediatric studies randomizing patients according to whether TIPS has been performed or not, and assessing TIPS effectiveness prior to transplantation. Nevertheless, our series and all pediatric series analyzed (4)(5)(6)(7)(8)(9)(10)(11)(12) describe an improvement in PH complications. Therefore, if patient baseline condition improves, LT and patient survival should improve, too.…”

“…TIPS has demonstrated to be a safe and effective technique to alleviate PH in adult patients (1,13,14) . In pediatric patients, experience is more limited as a result of PH being less frequent (7,12) . However, in the last years, various series of children undergoing TIPS (4)(5)(6)(7)(8)(9)(10)(11)(12) have been published.…”

“…In pediatric patients, experience is more limited as a result of PH being less frequent (7,12) . However, in the last years, various series of children undergoing TIPS (4)(5)(6)(7)(8)(9)(10)(11)(12) have been published. One of the longest series, which was published in 2019, is Bertino F et al (4) , with 59 cases, as well as Johansen LC's (11) , which was published in 2018, with 40 patients.…”

“…This technique is frequent in adult cirrhosis patients with PH -both as an acute and as a chronic treatmentin order to reduce complications, and as a previous step to liver transplantation (LT) or a palliative treatment in patients non-eligible for LT (1,3) . Although there are recent series of pediatric patients with TIPS (4)(5)(6)(7)(8)(9)(10)(11)(12) , experience in this age group is limited as a result of PH being less common.…”