Feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in children.
OBJECTIVE
Transjugular intrahepatic portosystemic shunt (TIPS) is a valuable tool in managing complications of severe portal hypertension (PH) in adults. In children, TIPS is regarded as a temporary and technically demanding procedure. We report the first paediatric series of TIPS and review its feasibility and efficacy in children.


METHODS
Children with severe PH that is unresponsive to nonselective β-blockers and endoscopic treatment were considered candidates for TIPS placement with an expanded polytetrafluoroethylene-covered Viatorr stent graft. Indications were cirrhotic PH, noncirrhotic PH, and portal vein thrombosis, in both native and transplanted livers.


RESULTS
Thirteen children were selected for TIPS between 2005 and 2010. The indications were bleeding in 8 (61.5%) and ascites in 5 (38.5%). TIPS was successfully placed in 11 children, median age 9.8 years (range 2.2-18) and median weight 30 kg (11.5-96). Two patients had a portal cavernoma and 3 had received split liver transplantation. Following TIPS, the portosystemic gradient decreased to 10 mmHg (5-15 mmHg) (P < 0.00001); PH complications resolved in 10 of 11 patients (91%); no patient developed clinical encephalopathy; and 3 patients required a TIPS revision. All of the shunts were patent at last follow-up (20.4 months, range 0.2-67) in 7 or liver transplantation (6 months, 1.5-33) in 4.


CONCLUSIONS
Our results suggest that TIPS is feasible and effective in children with ascites or gastrointestinal bleeding unresponsive to medical and endoscopic treatment. TIPS should become part of the armamentarium that is used to manage PH complications in children, both in native livers and in transplanted grafts, as a bridge to transplantation and for long-term management.
Paediatric Hepatology, Gastroenterology and Transplantation, Ospedali Riuniti di Bergamo, Bergamo, Italy.
Angelo
A
Di Giorgio
Roberto
R
Agazzi
Daniele
D
Alberti
Michele
M
Colledan
Lorenzo
L
D'Antiga
D000293:Adolescent; D001201:Ascites / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006501:Hepatic Encephalopathy / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D018579:Patient Selection; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D012189:Retrospective Studies
D011138:Polytetrafluoroethylene