Transjugular intrahepatic portosystemic shunt for liver transplantation.
OBJECTIVE
To assess transjugular intrahepatic portosystemic shunt (TIPSS) as an effective bridge between the control of variceal bleeding or refractory ascites and orthotopic liver transplantation (OLTx) and to examine whether TIPSS influences the operative procedures of OLTx.


METHODS
Five patients treated by TIPSS prior to OLTx were retrospectively reviewed.


RESULTS
The patients were followed up for 2-7 months (average 4.2 months) after transplantation. Transplantation was performed at a mean of 9.6 months (range 0.2-24.7) after TIPSS insertion. In four patients, stents were predominantly intrahepatic and they did not interfere with OLTx. In one patient, the stent extended into the portal vein, requiring removal during OLTx by division of the stent with the recipient portal vein. All patients are alive and none has portal vein thrombosis. No difference was observed in operation time, blood transfusion, and the length of hospital stay.


CONCLUSIONS
TIPSS is an effective bridge to OLTx for the control of variceal hemorrhage or refractory ascites. Our results suggest that TIPSS does not increase surgical morbidity or mortality, but optimal TIPSS placement within the liver is emphasized to facilitate subsequent OLTx.
Zhou
Guang-Wen
GW
Department of Surgery, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China. gw_vrai@fm365.com
Cai
Wei-Yao
WY
Li
Hong-Wei
HW
Zhu
Yue
Y
Dodson
Forrest
F
Fung
John J
JJ
D000328:Adult; D001201:Ascites / Q000601:surgery; D004932:Esophageal and Gastric Varices / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D016896:Treatment Outcome