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Transjugular intrahepatic portosystemic shunt after adult liver transplantation: experience in eight patients.

Transjugular intrahepatic portosystemic shunt after adult liver transplantation: experience in eight patients.

Authors :
Lerut JP
Goffette P
Molle G
Roggen FM
Puttemans T
Brenard R
Morelli MC
Wallemacq P
Van Beers B
Laterre PF
Source :
Transplantation [Transplantation] 1999 Aug 15; Vol. 68 (3), pp. 379-84.
Publication Year :
1999

Abstract

Background: Transjugular intrahepatic portosystemic shunting (TIPS) has become an effective treatment for the complications of portal hypertension. We assessed the feasibility and outcome of TIPS in liver transplant recipients.<br />Methods: During the period from December 1992 to January 1998, eight adults presenting recurrent hepatitis C virus (five patients) and hepatitis B virus (one patient) infection, veno-occlusive disease (one patient), and secondary biliary cirrhosis (one patient) had TIPS because of refractory ascites (five patients), bleeding esophageal varices (one patient), refractory hepatic hydrothorax (one patient), retransplantation (two patients), and redo-biliary surgery (one patient).<br />Results: In two patients, the procedure was difficult due to cavo-caval implantation. Ascites, hydrothorax, and variceal bleeding were controlled in all patients. Moderate to severe encephalopathy developed in four patients; two patients had worsening of their existing encephalopathy. Three of five patients treated with cyclosporine needed a drastic dose reduction due to the development of severe side effects. No long-term survivor developed shunt stenosis or occlusion. Two patients did moderately well at 6 and 14 months, respectively; the former died due to chronic rejection while waiting for a retransplantation. Three did well at 14, 36, and 28 months, respectively; the latter patient died of liver failure 32 months after TIPS. One jaundiced patient died after 1.5 months due to necrotic pancreatitis. Two patients died after 4 and 8.5 months, respectively, due to liver failure; the latter was doing well until 7 months after TIPS.<br />Conclusions: TIPS is feasible in transplant recipients in cases of decompensated allograft cirrhosis, of allograft veno-occlusive disease or when retransplantation or redo-biliary surgery are scheduled in the presence of portal hypertension. At transplantation, the surgeon should keep in mind the eventuality of a later TIPS procedure. Close immunosuppression monitoring is warranted because modified metabolization of cyclosporine (and probably tacrolimus) may cause serious side effects.

Details

Language :
English
ISSN :
0041-1337
Volume :
68
Issue :
3
Database :
MEDLINE
Journal :
Transplantation
Publication Type :
Academic Journal
Accession number :
10459541
Full Text :
https://doi.org/10.1097/00007890-199908150-00009