Transjugular intrahepatic portosystemic shunt in liver transplant recipients: indications, feasibility, and outcomes

The role of transjugular intrahepatic portosystemic shunt (TIPS) for treating complications of portal hypertension after orthotopic liver transplantation (OLT) is unclear. In this review of 13 retrospective studies and 8 case reports comprising 213 patients, we assessed the indications, technical success, and clinical outcomes of TIPS procedures performed in patients who had undergone OLT. Indications for TIPS were refractory ascites (n = 168), variceal hemorrhage (n = 36), and hydrothorax (n = 9). Technical success was reported in 98 % of cases. Five procedures failed because of portal vein thrombosis, caval tear, technical inability, patient instability, and unknown reasons (one each). Clinical success of TIPS after OLT was 57 % in patients with refractory ascites, 69 % in those with variceal hemorrhage, and 56 % in those with hydrothorax. TIPS revision was required in 16 % of cases, while 19 % of patients underwent subsequent retransplantation. Postprocedural or worsening encephalopathy occurred in 33 % of patients. Survival analysis based on 122 cases with data available revealed a 30-day mortality rate of 11 %, a 1-year cumulative survival rate of 53 %, and a 1-year cumulative retransplantation-free survival rate of 41 %. Given the complexity of post-OLT cases with complications of recurrent portal hypertension, it is not surprising that the overall clinical success rate of TIPS was relatively low. Nevertheless, TIPS may remain a viable choice for the treatment of patients who have undergone OLT with recurrent portal hypertensive complications when medical therapy is unsuccessful.