TIPSS for variceal hemorrhage after living related liver transplantation: a dangerous indication.
The introduction of transjugular intrahepatic portal-systemic stent-shunt (TIPSS) has been a major breakthrough in the treatment of portal hypertension, which has evolved to a large extent, into a routine procedure. A 21-year-old male patient with progressive graft fibrosis/cirrhosis requiring TIPSS for variceal hemorrhage in the esophagus due to portal hypertension was unresponsive to conventional measures two years after living related liver transplantation (LDLT). Subsequently, variceal hemorrhage was controlled, however, liver function decreased dramatically with consecutive multi organ failure. CT scan revealed substantial necrosis in the liver. The patient underwent successful "high urgent" cadaveric liver transplantation and was discharged on postoperative d 20 in a stable condition.
Schemmer
Peter
P
Department of General Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. peterschemmer@med.uni-heidelberg.de
Radeleff
Boris
B
Flechtenmacher
Christa
C
Mehrabi
Arianeb
A
Richter
Gotz M
GM
Buchler
Markus W
MW
Schmidt
Jan
J
D000328:Adult; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D006470:Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D019168:Portasystemic Shunt, Transjugular Intrahepatic