title: Transjugular intrahepatic portosystemic shunt for hepatitis C virus-related portal hypertension after liver transplantation.
abstract: This is a single center retrospective review of 19 consecutive liver transplant (LT) patients with hepatitis C virus (HCV)-related graft recurrent hepatitis who underwent transjugular intrahepatic portosystemic shunt (TIPS) at a median interval of 21 months (range: 5-50) from LT. Indications were refractory ascites in 11 patients (57.9%), hydrothorax in six (31.6%), and both in two (10.5%). TIPS was successful in 94.7% of cases (18/19) with only one procedure-related mortality (5.3%) owing to sepsis on day 35. At a median follow-up of 23 months (range: one month-nine yr), TIPS allowed for symptoms resolution in 16 patients (84.2%), with ascites resolving in all cases and hydrothorax persisting in 2. Post-TIPS patient survival at six months, one yr, and three yr was 84.2%, 73.7%, and 56.8%, respectively. We compared these results with a control group of 29 patients with HCV recurrence but without unresponsive ascites or hydrothorax. Patients in the control group had better survival than patients undergoing TIPS placement. However, survival of TIPS patients with a MELD score lower than or equal to 12 was similar to that of the control group. We conclude that TIPS may be used to treat complications secondary to HCV.
authors.affiliation: General Surgery and Liver Transplantation Unit, Department of Liver Transplantation, Hepatology, and Infectious Diseases, Cisanello Hospital, University of Pisa, Pisa, Italy. d.ghinolfi@yahoo.it
authors.forename: Davide
authors.initials: D
authors.lastname: Ghinolfi
authors.forename: Paolo
authors.initials: P
authors.lastname: De Simone
authors.forename: Gabriele
authors.initials: G
authors.lastname: Catalano
authors.forename: Stefania
authors.initials: S
authors.lastname: Petruccelli
authors.forename: Laura
authors.initials: L
authors.lastname: Coletti
authors.forename: Paola
authors.initials: P
authors.lastname: Carrai
authors.forename: Josep
authors.initials: J
authors.lastname: Marti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tincani
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicorelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Cioni
authors.forename: Franco
authors.initials: F
authors.lastname: Filipponi
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000472:pathogenicity; D006526:Hepatitis C / Q000150:complications* / Q000821:virology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence