Ces radiol. 2021, 75(2):148-153 | DOI: 10.55095/CesRadiol2021/017

Transjugular intrahepatic portosystemic shunt in patients after liver transplantationOriginal article

Jan Mašek1, Tomáš Fejfar2, Soňa Fraňková3, Libuše Husová4, Ondřej Renc1, Vendelín Chovanec1, Antonín Krajina1, Jan Raupach1
1 Radiologická klinika LF UK a FN, Hradec Králové
2 II. interní gastroenterologická klinika LF UK a FN, Hradec Králové
3 Klinika hepatogastroenterologie IKEM, Praha
4 Centrum kardiovaskulární a transplantační chirurgie, Brno

Aim: Transjugular intrahepatic portosystemic shunt is used to treat complications of clinically significant portal hypertension which can also develop in patients after liver transplantation. The study examines the results of treatment in 6 patients who underwent TIPS between 2007 and 2018.

Methods: TIPS was inserted in 6 patients (4 males, 2 females, aged 36 to 62 years) in the period between 2007 a 2018. All patients had previously undergone liver transplantation (5 for liver cirrhosis, 1 for Budd-Chiari syndrome). The piggyback caval reconstruction technique was used in 4/6 cases during transplantation. Causes of the development of portal hypertension in transplant recipients were recurrence of previous liver disease in 50% and sinusoidal obstruction syndrome in 50% of cases. TIPS was inserted in the median of 30 months after transplantation, standard technique was used in all cases. Indications were refractory ascites in 4 cases and variceal bleeding in 2 cases.

Results: Significant reduction of portosystemic gradient after TIPS was achieved in all cases. A technical complication developed in one patient. One patient died shortly after the procedure. Portal hypertension regressed in 5 patients. Late complications were reported in two patients. One case required liver retransplantation 5 years after TIPS placement. Median duration of TIPS patency was 55 months.

Conclusions: TIPS is rarely indicated in patients after liver transplantation. The procedure is, however, technically feasible. Favorable clinical outcomes of TIPS were achieved particularly in patients with sinusoidal obstruction syndrome, indicated for refractory ascites.

Keywords: liver, TIPS, transplantation, portal hypertension

Accepted: April 21, 2021; Published: June 1, 2021  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Mašek J, Fejfar T, Fraňková S, Husová L, Renc O, Chovanec V, et al.. Transjugular intrahepatic portosystemic shunt in patients after liver transplantation. Ces radiol. 2021;75(2):148-153. doi: 10.55095/CesRadiol2021/017.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Krajina A, Hulek P, Fejfar T, Valek V. Quality improvement guidelines for Transjugular Intrahepatic Portosystemic Shunt (TIPS). Cardiovasc Intervent Radiol 2012; 35(6): 1295-1300. doi: 10.1007/s00270-012-0493-y Go to original source... Go to PubMed...
    2. de Franchis R, Baveno VI. Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63(3): 743-752. doi: 10.1016/j.jhep.2015.05.022 Go to original source... Go to PubMed...
    3. Bonnel AR, Bunchorntavakul C, Rajender Reddy K. Transjugular intrahepatic portosystemic shunts in liver transplant recipients. Liver Transpl 2014; 20(2): 130-139. doi: 10.1002/lt.23775 Go to original source... Go to PubMed...
    4. Chen B, Wang W, Tam MD, Quintini C, Fung JJ, Li X. Transjugular intrahepatic portosystemic shunt in liver transplant recipients: indications, feasibility, and outcomes. Hepatol Int 2015; 9(3): 391-398. doi: 10.1007/s12072-015-9632-2 Go to original source... Go to PubMed...
    5. Statistiky. Koordinační středisko transplantací [online]. Praha [cit. 2021-03-29]. Dostupné z: https://kst.cz/
    6. Chan T, DeGirolamo K, Chartier-Plante S, Buczkowski AK. Comparison of three caval reconstruction techniques in orthotopic liver transplantation: A retrospective review. Am J Surg 2017; 213(5): 943-949. doi: 10.1016/j.amjsurg.2017.03.045 Go to original source... Go to PubMed...
    7. Schembri V, Cassinotto C, Panaro F, et al. Challenging TIPS in Liver Transplant Recipients: The Pull-Through Technique to Address Piggyback Anastomosis. Cardiovasc Intervent Radiol 2018; 41(5): 804-810. doi: 10.1007/s00270-018-1886-3 Go to original source... Go to PubMed...
    8. King A, Masterton G, Gunson B, et al. A case-controlled study of the safety and efficacy of transjugular intrahepatic portosystemic shunts after liver transplantation. Liver Transpl 2011; 17(7): 771-778. doi: 10.1002/lt.22281 Go to original source... Go to PubMed...
    9. Bucher JN, Hollenbach M, Strocka S, et al. Segmental intrahepatic cholestasis as a technical complication of the transjugular intrahepatic porto-systemic shunt. World J Gastroenterol 2019; 25(43): 6430-6439. doi: 10.3748/wjg.v25.i43.6430 Go to original source... Go to PubMed...
    10. Parvinian A, Bui JT, Knuttinen MG, Minocha J, Gaba RC. Transjugular intrahepatic portosystemic shunt for the treatment of medically refractory ascites. Diagn Interv Radiol 2014; 20(1): 58-64. doi: 10.5152/dir.2013.13131 Go to original source... Go to PubMed...
    11. Saad WE. Transjugular Intrahepatic Portosystemic Shunt before and after Liver Transplantation. Semin Intervent Radiol 2014; 31(3): 243-247. doi: 10.1055/s-0034-1382791 Go to original source... Go to PubMed...
    12. Salerno F, Camma C, Enea M, Rossle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a metaanalysis of individual patient data. Gastroenterology 2007; 133: 825-834. doi: 10.1053/j.gastro.2007.06.020 Go to original source... Go to PubMed...
    13. Bai M, Qi XS, Yang ZP, Yang M, Fan DM, Han GH. TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: an updated meta-analysis. World J Gastroenterol 2014; 20(10): 2704-2714. doi: 10.3748/wjg.v20.i10.2704 Go to original source... Go to PubMed...
    14. Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A, Mathurin P, Otal P, Cabarrou P, Péron JM, Vinel JP. Transjugular Intrahepatic Portosystemic Shunts With Covered Stents Increase Transplant-Free Survival of Patients With Cirrhosis and Recurrent Ascites. Gastroenterology 2017; 152(1): 157-163. doi: 10.1053/j.gastro.2016.09.016 Go to original source... Go to PubMed...
    15. Takamura H, Nakanuma S, Hayashi H, et al. Severe veno-occlusive disease/sinusoidal obstruction syndrome after deceased-donor and living-donor liver transplantation. Transplant Proc 2014; 46(10): 3523-3535. doi: 10.1016/j.transproceed.2014.09.110 Go to original source... Go to PubMed...
    16. Sebagh M, Azoulay D, Roche B, Hoti E, Karam V, Teicher E, Bonhomme-Faivre L, Saliba F, Duclos-Vallée JC, Samuel D. Significance of isolated hepatic veno-occlusive disease/sinusoidal obstruction syndrome after liver transplantation. Liver Transpl 2011; 17(7): 798-808. doi: 10.1002/lt.22282 Go to original source... Go to PubMed...
    17. Valla DC, Cazals-Hatem D. Sinusoidal obstruction syndrome. Clin Res Hepatol Gastroenterol 2016; 40(4): 378-385. doi: 10.1016/j.clinre.2016.01.006 Go to original source... Go to PubMed...
    18. Campos-Varela I, Castells L, Dopazo C, et al. Transjugular intrahepatic portosystemic shunt for the treatment of sinusoidal obstruction syndrome in a liver transplant recipient and review of the literature. Liver Transpl 2012; 18(2): 201-205. doi: 10.1002/lt.22351 Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content