Transjugular intrahepatic portosystemic shunt in liver transplant recipients.
OBJECTIVE
To evaluate the efficacy of transjugular intrahepatic portosystemic shunts (TIPSs) after liver transplantation (LT).


METHODS
Between November 1996 and December 2005, 10 patients with severe recurrent hepatitis C virus infection (n = 4), ductopenic rejection (n = 5) or portal vein thrombosis (n = 1) were included in this analysis. Eleven TIPSs (one patient underwent two TIPS procedures) were placed for management of therapy-refractory ascites (n = 7), hydrothorax (n = 2) or bleeding from colonic varices (n = 1). The median time interval between LT and TIPS placement was 15 (4-158) mo.


RESULTS
TIPS placement was successful in all patients. The mean portosystemic pressure gradient was reduced from 12.5 to 8.7 mmHg. Complete and partial remission could be achieved in 43% and 29% of patients with ascites. Both patients with hydrothorax did not respond to TIPS. No recurrent bleeding was seen in the patient with colonic varices. Nine of 10 patients died during the study period. Only one of two patients, who underwent retransplantation after the TIPS procedure, survived. The median survival period after TIPS placement was 3.3 (range 0.4-20) mo. The majority of patients died from sepsis with multiorgan failure.


CONCLUSIONS
Indications for TIPS and technical performance in LT patients correspond to those in non-transplanted patients. At least partial control of therapy-refractory ascites and variceal bleeding could be achieved in most patients. Nevertheless, survival rates were disappointing, most probably because of the advanced stages of liver disease at the time of TIPS placement and the high risk of sepsis as a consequence of immunosuppression.
Finkenstedt
Armin
A
Department of Internal Medicine II (Gastroenterology and Hepatology), Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria.
Graziadei
Ivo W
IW
Nachbaur
Karin
K
Jaschke
Werner
W
Mark
Walter
W
Margreiter
Raimund
R
Vogel
Wolfgang
W
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000706:statistics & numerical data; D011312:Pressure; D012189:Retrospective Studies