Transjugular intrahepatic portosystemic shunt in patients who have undergone liver transplantation

被引:37
作者
Amesur, NB
Zajko, AB
Orons, PD
Sammon, JK
Casavilla, FA
机构
[1] Univ Pittsburgh, Med Ctr, Dept Radiol, Pittsburgh, PA 15213 USA
[2] Univ Pittsburgh, Med Ctr, Dept Surg, Pittsburgh, PA 15213 USA
关键词
hypertension; portal; liver; transplantation; shunts; portosystemic;
D O I
10.1016/S1051-0443(99)70085-0
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
PURPOSE: Transjugular intrahepatic portosystemic shunt (TIPS) placement is an accepted treatment for refractory variceal bleeding and/or ascites in end-stage liver disease and is an effective bridge to liver transplantation. The authors present their experience with TIPS in patients with a liver transplant, who subsequently developed portal hypertension. MATERIALS AND METHODS: Thirteen TIPS were placed in 12 adult patients from 6 months to 13 years after liver transplantation for variceal bleeding that failed endoscopic treatment (n = 6) and intractable ascites (n = 6), All patients were followed to either time of retransplantation or death. RESULTS: No technical difficulties were encountered in TIPS placement in any of the patients. Four of six patients treated for bleeding stopped bleeding and did not experience re-bleeding; two had functional TIPS at 3 and 36 months and two underwent retransplantation at 3 and 7 months, Two patients had recurrent bleeding within 1 week and required reintervention, In the ascites group, one is 32 months since TIPS placement with control of his ascites, two patients underwent retransplantation at 2 and 6 weeks with interval improvement in ascites, Two patients died within a week of TIPS of fulminant hepatic failure. The last patient died 1 month after TIPS subsequent to a splenectomy, CONCLUSION: In conclusion, the placement of a TIPS in a transplanted liver, in general, requires no special technical considerations compared to placement in native livers. Although this series is small, the authors believe that TIPS should be considered a treatment option in liver transplant recipients who present with refractory variceal bleeding, TIPS may have a role in the management of intractable ascites.
引用
收藏
页码:569 / 573
页数:5
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