Rescue of a Marginal Liver Graft by Sequential Treatment With Molecular Adsorbent Recirculating System and Transjugular Intrahepatic Portosystemic Shunt: A Case Report

A 53-year-old man with alcoholic liver cirrhosis underwent orthotopic liver transplantation (OLT) using a marginal graft. Persistent cholestasis post-OLT was successfully treated using a molecular adsorbent recirculating system (MARS). Afterwards, the patient developed refractory ascites, which was controlled by a transjugular intrahepatic portosystemic shunt (TIPS). TIPS reduction and eventually occlusion was necessary due to the development of encephalopathy. Despite TIPS occlusion, the ascites did not relapse probably because of the onset of other adaptive mechanisms. MARS and TIPS used sequentially were capable of rescuing a liver graft, thereby avoiding the morbidity and mortality associated with early retransplantation and sparing a liver graft from the donor pool.