title: Pretransplant Portal Vein Recanalization-Transjugular Intrahepatic Portosystemic Shunt in Patients With Complete Obliterative Portal Vein Thrombosis.
abstract: BACKGROUND
  Chronic, obliterative portal vein (PV) thrombosis (PVT) represents a relative contraindication to liver transplantation (LT) in some centers. When PV thromboembolectomy is not feasible, alternative techniques (portacaval hemitransposition, portal arterialization, multivisceral transplantation) are associated with suboptimal outcomes. In cases where a chronically thrombosed PV has become obliterated, we developed PV recanalization (PVR)-transjugular intrahepatic portosystemic shunt (TIPS) to potentiate LT. We evaluated the impact of PVR-TIPS on liver function, transplant eligibility, and long-term outcomes after LT.
  
  
  METHODS
  Forty-four patients with chronic obliterative main PVT were identified during our institutional LT selection committee. After joint imaging review by transplant surgery/radiology, these patients underwent PVR-TIPS to potentiate transplant eligibility. Patients were followed by hepatology/transplant until LT, and ultimately in posttransplant clinic. The TIPS venography and serial ultrasound/MRI were used subsequently to document PV patency.
  
  
  RESULTS
  The main PV (MPV) was completely thrombosed in 17 of 44 (39%) patients; near complete (>95%) occlusion was noted in 27 of 44 (61%) patients. Direct transhepatic and transsplenic punctures were required in 11 of 43 (26%) and 3 of 43 (7%) cases, respectively. Technical success was 43 of 44 (98%) cases. At PVR-TIPS completion, persistence of MPV thrombus was noted in 33 of 43 (77%) cases. One-month TIPS venography demonstrated complete resolution of MPV thrombosis in 22 of 29 (76%) without anticoagulation. Thirty-six patients were listed for transplantation; 18 (50%) have been transplanted. Eighty-nine percent MPV patency rate and 82% survival were achieved at 5 years.
  
  
  CONCLUSIONS
  The PVR-TIPS may be considered for patients with obliterative PVT who are otherwise appropriate candidates for LT. The high rate of MPV patency post-TIPS placement suggests flow reestablishment as the dominant mechanism of thrombus resolution.
authors.affiliation: 1Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago IL. 2Department of Transplantation, Northwestern University, Chicago, IL. 3Liver Unit, Clinica Universidad de Navarra, Pamplona, Navarra, Spain. 4Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Barcelona, Spain. 5Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL.
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Michael
authors.initials: M
authors.lastname: Vouche
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: Herrero
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Caicedo
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fryer
authors.forename: Ryan
authors.initials: R
authors.lastname: Hickey
authors.forename: Ali
authors.initials: A
authors.lastname: Habib
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.forename: Felicitas
authors.initials: F
authors.lastname: Koller
authors.forename: Robert
authors.initials: R
authors.lastname: Vogelzang
authors.forename: Kush
authors.initials: K
authors.lastname: Desai
authors.forename: Bartley
authors.initials: B
authors.lastname: Thornburg
authors.forename: Elias
authors.initials: E
authors.lastname: Hohlastos
authors.forename: Scott
authors.initials: S
authors.lastname: Resnick
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Kent
authors.initials: K
authors.lastname: Sato
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Daniel
authors.initials: D
authors.lastname: Ganger
authors.forename: Laura
authors.initials: L
authors.lastname: Kulik
mesh_terms: D000328:Adult; D000368:Aged; D002641:Chicago; D002908:Chronic Disease; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008102:Liver Circulation; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult