Transjugular intrahepatic portosystemic shunts: impact on liver transplantation.

J. M. Millis, Paul Martin, A. Gomes, A. Shaked, S. D. Colquhoun, O. Jurim, L. Goldstein, R. W. Busuttil

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

This study was designed to evaluate the impact of transjugular intrahepatic portosystemic shunts (TIPS) on liver transplantation. Historically, the complications of portal hypertension have been temporized with sclerotherapy or surgical portosystemic shunts. In patients whose liver disease progressed, liver transplantation has been used as definitive treatment. More recently, TIPS is being used increasingly for the management of the complications of portal hypertension. The impact of this new modality on liver transplantation is evaluated. The records of 135 adult patients undergoing liver transplantation at University of California at Los Angeles between October 1992 and June 1993 were reviewed. Twenty-three patients had received at least one shunt before transplantation. The TIPS procedure complicated the operative course of 5 patients (22%). In 2 patients the TIPS had been placed cephalad, making placement of the suprahepatic vena caval clamp difficult. In 2 other patients, the shunt had been placed caudad, extending in the extrahepatic portal vein. In all 4 of these patients, the intima had been damaged at the area of the subsequent anastomosis. In the fifth patient, the bile duct had been perforated during the placement of the shunt, causing diffuse bile peritonitis, which was sterile, and the transplantation was performed. The average intraoperative blood loss for these 5 patients was 13 U. There was no significant decrease in intraoperative blood loss for all patients with a TIPS when compared with 112 adults who underwent liver transplantation during the same period (11 U v 10.5 U). The TIPS stent did not improve objective intraoperative parameters as compared with liver transplant recipients without TIPS. The indications for TIPS must be carefully weighed against the potential risks of increasing the technical difficulty of the transplantation and jeopardizing the candidacy of some liver transplantation candidates. Liver transplantation is not facilitated by TIPS insertion and therefore should not be used to justify TIPS placement.

Original languageEnglish
Pages (from-to)229-233
Number of pages5
JournalLiver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Volume1
Issue number4
StatePublished - Jul 1 1995
Externally publishedYes

Fingerprint

Transjugular Intrahepatic Portasystemic Shunt
Liver Transplantation
Transplantation
Portal Hypertension
Surgical Portasystemic Shunt
Venae Cavae
Sclerotherapy
Los Angeles
Operative Surgical Procedures
Portal Vein
Bile Ducts
Peritonitis
Bile
Stents
Liver Diseases

ASJC Scopus subject areas

  • Hepatology
  • Surgery

Cite this

Transjugular intrahepatic portosystemic shunts : impact on liver transplantation. / Millis, J. M.; Martin, Paul; Gomes, A.; Shaked, A.; Colquhoun, S. D.; Jurim, O.; Goldstein, L.; Busuttil, R. W.

In: Liver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, Vol. 1, No. 4, 01.07.1995, p. 229-233.

Research output: Contribution to journalArticle

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