title: Transjugular intrahepatic portosystemic shunts for refractory ascites after liver transplantation.
abstract: OBJECTIVE
  To study the efficacy of transjugular intrahepatic portosystemic shunts (TIPS) in the management of refractory ascites after liver transplantation.
  
  
  METHODS
  Between January 1995 and December 2003, 309 primary adult liver transplants were performed. Refractory ascites was defined as active interventions (salt restriction, diuretic use, repeated paracentesis) needed beyond 30 days after transplantation. These patients were managed with TIPS placement.
  
  
  RESULTS
  Eight TIPS were placed in 8 patients at a mean of 11.5 months after transplantation (range, 2-36 months). There were 5 males and 3 females, age 54 +/- 8.2 years. Hepatitis C was the primary diagnosis in 7 patients and primary biliary cirrhosis in 1. Indications for TIPS included refractory ascites (8), associated variceal bleeding (2), and various degrees of hepatic vein outflow stenosis (3). Seven patients had resolution of ascites and associated findings of portal hypertension, and 1 patient with persistent ascites had severe hepatic vein outflow stenosis and associated hepatitis C in the allograft. Two patients required retransplantation for recurrent hepatitis C. There were 3 deaths: liver failure (1), organ failure after retransplantation (1), and lung cancer 5 months after TIPS (1). Currently, 5 patients are alive without clinical evidence of ascites 9, 13, 15, 24, and 70 months after TIPS.
  
  
  CONCLUSIONS
  The TIPS device can be used safely and effectively to control refractory ascites after liver transplantation. In the setting of organ dysfunction, these patients should be considered sooner for retransplantation.
authors.affiliation: Division of Transplantation Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA. maboulj5@hfhs.org
authors.forename: M
authors.initials: M
authors.lastname: Abouljoud
authors.forename: A
authors.initials: A
authors.lastname: Yoshida
authors.forename: D
authors.initials: D
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Jerius
authors.forename: J
authors.initials: J
authors.lastname: Arenas
authors.forename: M
authors.initials: M
authors.lastname: Raoufi
authors.forename: K
authors.initials: K
authors.lastname: Brown
authors.forename: D
authors.initials: D
authors.lastname: Moonka
mesh_terms: D000328:Adult; D001201:Ascites / Q000601:surgery*; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014648:Varicose Veins / Q000601:surgery