title: Impact of transjugular intrahepatic portosystemic shunting on liver transplantation: 12-year single-center experience.
abstract: BACKGROUND
  The purpose of this study was to assess the impact of transjugular intrahepatic portosystemic shunting (TIPS) on liver transplantation (LT).
  
  
  METHODS
  Seventy-two patients transplanted after TIPS insertion between 1996 and 2008 were compared with 136 matched patients transplanted without prior TIPS.
  
  
  RESULTS
  At time of LT, 10% of the TIPS were occluded and 32% were misplaced. Shunt removal was difficult in 17% of the TIPS patients and required vena cava clamping in 10%. Collateral venous circulation was less extensive and intra-operative portocaval anastomosis was required more frequently in the TIPS group. No significant difference in transfusion requirements and operative times were observed between the two groups. Postoperatively, liver and renal function tests, in-hospital stay, graft rejection, re-transplantation and 1-year mortality rates were not statistically different. Ascites volume in the first week was greater in the TIPS group (7.6 L vs 6.9 L, P=0.036). In the TIPS group, ascites and collateral circulation were greater if the shunt was occluded at the time of LT. Shunt misplacement or occlusion was not associated with higher intra-operative or postoperative complication rates.
  
  
  CONCLUSIONS
  TIPS did not impair LT and can provide a safe bridge for LT in the end-stage cirrhotic patients.
authors.affiliation: Department of Digestive Surgery and Liver Transplantation, AP-HM, Hôpital La Conception, 13005 Marseille, France; Aix-Marseille University, 13284 Marseille, France. Electronic address: louisebarbier@hotmail.fr.
authors.forename: Louise
authors.initials: L
authors.lastname: Barbier
authors.affiliation: Department of Digestive Surgery and Liver Transplantation, AP-HM, Hôpital La Conception, 13005 Marseille, France; Aix-Marseille University, 13284 Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Hardwigsen
authors.affiliation: Department of Hepato-Gastro-Enterology, AP-HM, Hôpital La Conception, 13005 Marseille, France; Aix-Marseille University, 13284 Marseille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Borentain
authors.affiliation: Department of Digestive Surgery and Liver Transplantation, AP-HM, Hôpital La Conception, 13005 Marseille, France; Aix-Marseille University, 13284 Marseille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Biance
authors.affiliation: Department of Digestive Surgery and Liver Transplantation, AP-HM, Hôpital La Conception, 13005 Marseille, France; Aix-Marseille University, 13284 Marseille, France.
authors.forename: Amine
authors.initials: A
authors.lastname: Daghfous
authors.affiliation: Department of Radiology, AP-HM, Hôpital La Timone, 13005 Marseille, France; Aix-Marseille University, 13284 Marseille, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Louis
authors.affiliation: Department of Hepato-Gastro-Enterology, AP-HM, Hôpital La Conception, 13005 Marseille, France; Aix-Marseille University, 13284 Marseille, France.
authors.forename: Danielle
authors.initials: D
authors.lastname: Botta-Fridlund
authors.affiliation: Department of Digestive Surgery and Liver Transplantation, AP-HM, Hôpital La Conception, 13005 Marseille, France; Aix-Marseille University, 13284 Marseille, France.
authors.forename: Yves-Patrice
authors.initials: YP
authors.lastname: Le Treut
mesh_terms: D000328:Adult; D001201:Ascites / Q000601:surgery; D016022:Case-Control Studies; D003097:Collateral Circulation; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery; D006530:Hepatorenal Syndrome / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000706:statistics & numerical data; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D055815:Young Adult