Transjugular intrahepatic portosystemic shunt for liver transplantation

Objectives: To assess transjugular intrahepatic porto-systemic shunt (TIPSS) as an effective bridge be-tween the control of variceal bleeding or refractoryascites and orthotopic liver transplantation (OLTx)and to examine whether TIPSS influences the opera-tive procedures of OLTx.Methods: Five patients treated by TIPSS prior toOLTx were retrospectively reviewed.Results: The patients were followed up for 2-7months (average 4.2 months) after transplantation.Transplantation was performed at a mean of 9. 6months (range 0.2-24.7) after TIPSS insertion. Infour patients, stents were predominantly intrahepaticand they did not interfere with OLTx. In one pa-tient, the stent extended into the portal vein, requi-ring removal during OLTx by division of the stentwith the recipient portal vein. All patients are aliveand none has portal vein thrombosis. No differencewas observed in operation time, blood transfusion,and the length of hospital stay.Conclusions: TIPSS is an effective bridge to OLTxfor the control of variceal hemorrhage or refractoryascites. Our results suggest that TIPSS does not in-crease surgical morbidity or mortality, but optimalTIPSS placement within the liver is emphasized to fa-cilitate subsequent OLTx.