title: Transjugular intrahepatic portosystemic shunt for a wait list patient is not a contraindication for orthotopic liver transplant outcomes.
abstract: OBJECTIVE
  A transjugular intrahepatic portosystemic shunt for treating recurrent variceal bleeding or refractory ascites can be used as bridge therapy in patients awaiting a liver transplant. However, incorrect placement of the transjugular intrahepatic portosystemic shunt may complicate surgery during a liver transplant. This study sought to analyze a cohort of transplanted recipients to underscore whether transjugular intrahepatic portosystemic shunts can negatively affect liver transplant outcomes.
  
  
  METHODS
  We retrospectively analyzed 207 patients who had undergone a liver transplant between January 2001 and December 2009 in the Rome "La Sapienza" center. Transjugular intrahepatic portosystemic shunt was performed before the liver transplant in 36 cases (17%). The analyzed population was stratified into 2 groups (no transjugular intrahepatic portosystemic shunt [n=171 ] and transjugular intrahepatic portosystemic shunt [n=36 ]), and patient survival outcomes were compared.
  
  
  RESULTS
  In the no-transjugular intrahepatic portosystemic shunt group, 60 of 171 deaths (35%) were reported, 20 of which were seen in the first 3 months after the liver transplant. In the same group, 61 graft losses (36%) were observed, with 19 of which were seen in the first 3 months after the liver transplant. In transjugular intrahepatic portosystemic shunt group, 12 of the 36 deaths (33%) were seen; 5 patients died within 3 months of the liver transplant. In this latter group, 12 grafts (33%) were lost, 4 of which were reported during the first 3 months after surgery. The median patient survival was 64 months and 69 months in the 2 groups. On survival analysis, no significant differences were found between the 2 groups.
  
  
  CONCLUSIONS
  Transjugular intrahepatic portosystemic shunt does not seem to affect outcomes after a liver transplant. We suggest that clinicians recognized the location of the stent to prevent any difficulty during surgery.
authors.affiliation: Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Levi Sandri
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Melandro
authors.forename: Nicola
authors.initials: N
authors.lastname: Guglielmo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Mennini
authors.forename: Pasquale B
authors.initials: PB
authors.lastname: Berloco
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fanelli
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Salvatori
authors.forename: Massimo
authors.initials: M
authors.lastname: Rossi
mesh_terms: D000075202:Contraindications; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000401:mortality; D018579:Patient Selection; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality