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

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Abstract

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.

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Abbreviations

ESLD:

End-stage liver disease

IVC:

Inferior vena cava

OLT:

Orthotopic liver transplantation

SAE:

Splenic artery embolization

TIPS:

Transjugular intrahepatic portosystemic shunt

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Acknowledgements

The authors thank Megan Griffiths, scientific writer for the Imaging Institute, Cleveland Clinic, Cleveland, OH, USA, for her help with revising the manuscript. This study was partially supported by The National Natural Science Foundation of China, No. 81171444 and No. 81371656.

Conflict of interest

Bin Chen, Weiping Wang, Matthew D. Tam, Cristiano Quintini, John J. Fung, and Xiao Li declare that they have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China

    Bin Chen

  2. Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, People’s Republic of China

    Bin Chen

  3. Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Weiping Wang

  4. Department of Radiology, Southend University Hospital, NHS Foundation Trust, Essex, UK

    Matthew D. Tam

  5. Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Cristiano Quintini & John J. Fung

  6. Imaging Institute, Institution of Interventional Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People’s Republic of China

    Bin Chen & Xiao Li

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  1. Bin Chen
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  2. Weiping Wang
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  3. Matthew D. Tam
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  4. Cristiano Quintini
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  6. Xiao Li
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Correspondence to Xiao Li.

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Chen, B., Wang, W., Tam, M.D. et al. Transjugular intrahepatic portosystemic shunt in liver transplant recipients: indications, feasibility, and outcomes. Hepatol Int 9, 391–398 (2015). https://doi.org/10.1007/s12072-015-9632-2

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  • DOI: https://doi.org/10.1007/s12072-015-9632-2

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