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Transjugular intrahepatic portosystemic shunts in liver transplant recipients for management of refractory ascites: clinical outcome.
J Vasc Interv Radiol. 2010 Feb; 21(2):218-23.JV

Abstract

PURPOSE

To determine the effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) creation in liver transplant recipients with recurrent portal hypertension presenting with refractory ascites.

MATERIALS AND METHODS

A retrospective review of transplant recipients undergoing TIPS creation was performed over a 6-year period. Recipients were noted for age, sex, TIPS indication, Model for End-stage Liver Disease (MELD) score, cause of initial liver disease, and time between first transplantation and TIPS creation. Clinical success was defined as graft survival of longer than 1 month with improvement in ascites. New-onset or worsening encephalopathy was noted. Graft survival and patency were calculated according to the Kaplan-Meier method. MELD score and portosystemic gradient (PSG) before and after TIPS creation were evaluated for prediction of graft loss less than 3 months after TIPS creation.

RESULTS

Nineteen liver transplant recipients underwent TIPS creation for ascites. Mean time from transplantation was 3.5 years (range, 3.7-112.2 months). Mean MELD score before TIPS creation was 17 (range, 7-24). The technical, hemodynamic, and clinical success rates were 100%, 95%, and 16%, respectively. Encephalopathy developed in five patients (26%). Thirty- and 90-day mortality rates were 16% (n = 3) and 21% (n = 4), respectively. Primary unassisted patency and graft survival rates at 1, 3, and 6 months were 100%, 90%, and 90% and 79%, 58%, and 47%, respectively. MELD score parameters were significant indicators (P < .05) for graft survival beyond 3 months, but PSG parameters were not.

CONCLUSIONS

TIPS for the management of ascites in liver transplant recipients is not as clinically effective as it is in patients with native livers (16% vs 50%-80% in the literature). MELD score is a predictor of graft survival; PSG parameters are not.

Authors+Show Affiliations

Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA. wspikes@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20123207

Citation

Saad, Wael E A., et al. "Transjugular Intrahepatic Portosystemic Shunts in Liver Transplant Recipients for Management of Refractory Ascites: Clinical Outcome." Journal of Vascular and Interventional Radiology : JVIR, vol. 21, no. 2, 2010, pp. 218-23.
Saad WE, Darwish WM, Davies MG, et al. Transjugular intrahepatic portosystemic shunts in liver transplant recipients for management of refractory ascites: clinical outcome. J Vasc Interv Radiol. 2010;21(2):218-23.
Saad, W. E., Darwish, W. M., Davies, M. G., & Waldman, D. L. (2010). Transjugular intrahepatic portosystemic shunts in liver transplant recipients for management of refractory ascites: clinical outcome. Journal of Vascular and Interventional Radiology : JVIR, 21(2), 218-23. https://doi.org/10.1016/j.jvir.2009.10.025
Saad WE, et al. Transjugular Intrahepatic Portosystemic Shunts in Liver Transplant Recipients for Management of Refractory Ascites: Clinical Outcome. J Vasc Interv Radiol. 2010;21(2):218-23. PubMed PMID: 20123207.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transjugular intrahepatic portosystemic shunts in liver transplant recipients for management of refractory ascites: clinical outcome. AU - Saad,Wael E A, AU - Darwish,Wael M, AU - Davies,Mark G, AU - Waldman,David L, PY - 2008/11/06/received PY - 2009/10/24/revised PY - 2009/10/30/accepted PY - 2010/2/4/entrez PY - 2010/2/4/pubmed PY - 2010/4/17/medline SP - 218 EP - 23 JF - Journal of vascular and interventional radiology : JVIR JO - J Vasc Interv Radiol VL - 21 IS - 2 N2 - PURPOSE: To determine the effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) creation in liver transplant recipients with recurrent portal hypertension presenting with refractory ascites. MATERIALS AND METHODS: A retrospective review of transplant recipients undergoing TIPS creation was performed over a 6-year period. Recipients were noted for age, sex, TIPS indication, Model for End-stage Liver Disease (MELD) score, cause of initial liver disease, and time between first transplantation and TIPS creation. Clinical success was defined as graft survival of longer than 1 month with improvement in ascites. New-onset or worsening encephalopathy was noted. Graft survival and patency were calculated according to the Kaplan-Meier method. MELD score and portosystemic gradient (PSG) before and after TIPS creation were evaluated for prediction of graft loss less than 3 months after TIPS creation. RESULTS: Nineteen liver transplant recipients underwent TIPS creation for ascites. Mean time from transplantation was 3.5 years (range, 3.7-112.2 months). Mean MELD score before TIPS creation was 17 (range, 7-24). The technical, hemodynamic, and clinical success rates were 100%, 95%, and 16%, respectively. Encephalopathy developed in five patients (26%). Thirty- and 90-day mortality rates were 16% (n = 3) and 21% (n = 4), respectively. Primary unassisted patency and graft survival rates at 1, 3, and 6 months were 100%, 90%, and 90% and 79%, 58%, and 47%, respectively. MELD score parameters were significant indicators (P < .05) for graft survival beyond 3 months, but PSG parameters were not. CONCLUSIONS: TIPS for the management of ascites in liver transplant recipients is not as clinically effective as it is in patients with native livers (16% vs 50%-80% in the literature). MELD score is a predictor of graft survival; PSG parameters are not. SN - 1535-7732 UR - https://www.unboundmedicine.com/medline/citation/20123207/Transjugular_intrahepatic_portosystemic_shunts_in_liver_transplant_recipients_for_management_of_refractory_ascites:_clinical_outcome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-0443(09)01062-8 DB - PRIME DP - Unbound Medicine ER -