Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Apr 28, 2009; 15(16): 1999-2004
Published online Apr 28, 2009. doi: 10.3748/wjg.15.1999
Transjugular intrahepatic portosystemic shunt in liver transplant recipients
Armin Finkenstedt, Ivo W Graziadei, Karin Nachbaur, Werner Jaschke, Walter Mark, Raimund Margreiter, Wolfgang Vogel
Armin Finkenstedt, Ivo W Graziadei, Karin Nachbaur, Wolfgang Vogel, Department of Internal Medicine II (Gastroenterology and Hepatology), Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
Werner Jaschke, Department of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
Walter Mark, Raimund Margreiter, Department of Transplant Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
Author contributions: Finkenstedt A and Graziadei IW analyzed the data and wrote the paper; Graziadei IW and Vogel W designed the study; Nachbaur K, Jaschke W, Mark W and Margreiter R collected the data.
Correspondence to: Ivo W Graziadei, MD, Department of Internal Medicine II (Gastroenterology and Hepatology), Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria. ivo.graziadei@i-med.ac.at
Telephone: +43-512-50423401
Fax: +43-512-50424052
Received: January 21, 2009
Revised: March 11, 2009
Accepted: March 11, 2009
Published online: April 28, 2009
Abstract

AIM: To evaluate the efficacy of transjugular intrahepatic portosystemic shunts (TIPSs) after liver transplantation (LT).

METHODS: Between November 1996 and December 2005, 10 patients with severe recurrent hepatitis C virus infection (n = 4), ductopenic rejection (n = 5) or portal vein thrombosis (n = 1) were included in this analysis. Eleven TIPSs (one patient underwent two TIPS procedures) were placed for management of therapy-refractory ascites (n = 7), hydrothorax (n = 2) or bleeding from colonic varices (n = 1). The median time interval between LT and TIPS placement was 15 (4-158) mo.

RESULTS: TIPS placement was successful in all patients. The mean portosystemic pressure gradient was reduced from 12.5 to 8.7 mmHg. Complete and partial remission could be achieved in 43% and 29% of patients with ascites. Both patients with hydrothorax did not respond to TIPS. No recurrent bleeding was seen in the patient with colonic varices. Nine of 10 patients died during the study period. Only one of two patients, who underwent retransplantation after the TIPS procedure, survived. The median survival period after TIPS placement was 3.3 (range 0.4-20) mo. The majority of patients died from sepsis with multiorgan failure.

CONCLUSION: Indications for TIPS and technical performance in LT patients correspond to those in non-transplanted patients. At least partial control of therapy-refractory ascites and variceal bleeding could be achieved in most patients. Nevertheless, survival rates were disappointing, most probably because of the advanced stages of liver disease at the time of TIPS placement and the high risk of sepsis as a consequence of immunosuppression.

Keywords: Portal hypertension; Ascites; Variceal bleeding; Immunosuppression; Liver transplantation