title: Portosystemic shunt as a bridge to liver transplantation in infants: A comparison of two techniques.
abstract: Portosystemic shunts can serve as a bridge to liver transplantation in patients with end-stage liver disease by providing portal decompression to treat life-threatening variceal bleeding and prevent recurrent episodes until an organ becomes available. The conventional TIPS procedure, however, is technically challenging to perform in infants due to the small size of their intrahepatic vasculature. We report two cases of emergent creation of portosystemic shunts as a bridge to liver transplantation in infants with life-threatening variceal bleeding using a conventional TIPS technique in the first case and a percutaneous DIPS technique in the other. Both procedures were successful at reducing the portosystemic pressure gradient and preventing further variceal bleeds until a liver transplant could be performed. The novel percutaneous DIPS procedure is a valuable alternative to the conventional TIPS in infants, as it is better suited for small or challenging intrahepatic vascular anatomy.
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Dor
authors.initials: D
authors.lastname: Yoeli
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: N Thao N
authors.initials: NTN
authors.lastname: Galván
authors.affiliation: Department of Radiology, Division of Pediatric Radiology, Baylor College of Medicine, Houston, TX, USA.|Department of Radiology, Division of Interventional Radiology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ashton
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Kayla R
authors.identifier: http://orcid.org/0000-0003-0508-3557
authors.initials: KR
authors.lastname: Kumm
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kueht
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Ellen D
authors.initials: ED
authors.lastname: Witte
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA.|Department of Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Tamir A
authors.initials: TA
authors.lastname: Miloh
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Cotton
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Abbas
authors.initials: A
authors.lastname: Rana
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: O'Mahony
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Goss
mesh_terms: D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D011170:Portasystemic Shunt, Surgical / Q000379:methods*
keywords: end-stage liver disease; esophageal and gastric varices; gastrointestinal hemorrhage; liver transplantation; transjugular intrahepatic portosystemic shunt