Transjugular Intrahepatic Porto-Caval Shunt (TIPS) in treatment of portal hypertension in liver transplant recipiens.
BACKGROUND
TIPS, as non-operative treatment of portal hypertension allows for safe awaiting liver transplantation for patients otherwise at high risk of hemorrhage from oesophageal varices veins. When endoscopic treatment fails, TIPS is a plausible and less hazardous alternative for surgical porto-systemic shunts. It is of particular importance in patients with liver failure and unacceptable operative risk (group C in Child-Pugh classification).


METHODS
TIPS was done in 96 patients aged 16-68 years (average 52 years). According to Child-Pugh classification, which documents a stage of liver failure, 60 patients (62%) were in group B, and 36 (38%) in group C. Patients from group C are in most severe condition and at highest operative risk. Postalcoholic and postinflammatory liver cirrhosis is a main cause of portal hypertension.


RESULTS
TIPS was done in 26 patients expecting liver transplantation. Twenty patients had subsequently undergone liver transplantation while remaining 6 are still on the waiting list. In 15 patients stenosis of the shunt was observed within a year. Stenosis was then treated with intervention radiology and implantation of supplemental stents.


CONCLUSIONS
TIPS as a non-operative option for treatment of portal hypertension gives a patient an opportunity to await liver transplantation with maximum possible safety. Considering these facts, TIPS is called a bridge to liver transplantation.
Departament of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland. wroblewskitad@o2.pl
Tadeusz
T
Wróblewski
Olgierd
O
Rowiński
Jerzy
J
Zurakowski
Bogna
B
Ziarkiewicz-Wróblewska
Krzysztof
K
Zieniewicz
Paweł
P
Nyckowski
Marek
M
Krawczyk
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D017093:Liver Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography