Role of TIPS as a bridge to hepatic transplantation in Budd-Chiari syndrome.
OBJECTIVE
To investigate the role of transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to transplantation for patients with Budd-Chiari syndrome (BCS).


METHODS
Eight patients (five women, three men) with a mean age of 49.8 years (range, 20-61 years) were diagnosed with BCS by means of computed tomography, hepatic venography, and liver biopsy. One patient had acute liver failure, with subacute or chronic failure in seven. TIPS placement was attempted in all eight patients. Clinical follow-up and portograms were obtained in all patients until death or transplantation.


RESULTS
TIPS placement was completed in seven of eight patients (87.5%). During the follow-up period, TIPS occlusion occurred in four patients. TIPS revision in this patient, although successful, was complicated by hemorrhage and multiorgan failure, and the patient died. Assisted patency rate, excluding the technical failure, was 100%. Mean follow-up in the six survivors with TIPS was 342 days (range, 19-660 days). All six survivors had complete resolution of their ascites. Albumin levels improved an average of 0.43 g/dL (range, 0.3-1.4 g/dL). Bilirubin levels improved in five of six patients (83%), decreasing by an average of 5.6 mg/dL (range, 3.0-15.2 mg/dL). Of the six survivors, three underwent elective liver transplantation, one is awaiting transplantation, and one has been removed from the transplantation list because of clinical improvement. One patient was a candidate for transplantation but declined to be put on the list.


CONCLUSIONS
Hepatic synthetic dysfunction improves markedly after TIPS placement in patients with BCS. Significant improvement in ascites can also occur. TIPS can be an effective bridge to transplantation for patients with BCS.
Division of Interventional Radiology, University of Colorado Health Sciences Center, Denver, USA.
R K
RK
Ryu
J D
JD
Durham
J
J
Krysl
R
R
Shrestha
R
R
Shrestha
G T
GT
Everson
J
J
Stephens
I
I
Kam
M
M
Wachs
D A
DA
Kumpe
D000208:Acute Disease; D000328:Adult; D001201:Ascites / Q000601:surgery; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000601:surgery; D006801:Humans; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D010690:Phlebography; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000295:instrumentation; D011172:Portography; D019106:Postoperative Hemorrhage / Q000209:etiology; D012086:Reoperation; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D012709:Serum Albumin; D001663:Bilirubin