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A comparison of treatment with transjugular intrahepatic portosystemic shunt or distal splenorenal shunt in the management of variceal bleeding prior to liver transplantation.
Transplantation. 1995 Jan 27; 59(2):226-9.T

Abstract

Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT). Endoscopic sclerotherapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS) has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS). In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients) or DSRS (17 patients) for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P = 0.014) but transfusion requirements were similar. Intraoperative portal vein blood flow measurements averaged 2132 +/- 725 ml/min in the TIPS group compared with 1120 +/- 351 ml/min in the DSRS group (P < 0.001). Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P = 0.1). We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intraoperative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified.

Authors+Show Affiliations

Transplantation Services, Baylor University Medical Center, Dallas 75246.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

7839445

Citation

Abouljoud, M S., et al. "A Comparison of Treatment With Transjugular Intrahepatic Portosystemic Shunt or Distal Splenorenal Shunt in the Management of Variceal Bleeding Prior to Liver Transplantation." Transplantation, vol. 59, no. 2, 1995, pp. 226-9.
Abouljoud MS, Levy MF, Rees CR, et al. A comparison of treatment with transjugular intrahepatic portosystemic shunt or distal splenorenal shunt in the management of variceal bleeding prior to liver transplantation. Transplantation. 1995;59(2):226-9.
Abouljoud, M. S., Levy, M. F., Rees, C. R., Diamond, N. G., Lee, S. P., Mulligan, D. C., Goldstein, R. M., Husberg, B., Gonwa, T. A., & Klintmalm, G. B. (1995). A comparison of treatment with transjugular intrahepatic portosystemic shunt or distal splenorenal shunt in the management of variceal bleeding prior to liver transplantation. Transplantation, 59(2), 226-9.
Abouljoud MS, et al. A Comparison of Treatment With Transjugular Intrahepatic Portosystemic Shunt or Distal Splenorenal Shunt in the Management of Variceal Bleeding Prior to Liver Transplantation. Transplantation. 1995 Jan 27;59(2):226-9. PubMed PMID: 7839445.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of treatment with transjugular intrahepatic portosystemic shunt or distal splenorenal shunt in the management of variceal bleeding prior to liver transplantation. AU - Abouljoud,M S, AU - Levy,M F, AU - Rees,C R, AU - Diamond,N G, AU - Lee,S P, AU - Mulligan,D C, AU - Goldstein,R M, AU - Husberg,B, AU - Gonwa,T A, AU - Klintmalm,G B, PY - 1995/1/27/pubmed PY - 1995/1/27/medline PY - 1995/1/27/entrez SP - 226 EP - 9 JF - Transplantation JO - Transplantation VL - 59 IS - 2 N2 - Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT). Endoscopic sclerotherapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS) has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS). In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients) or DSRS (17 patients) for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P = 0.014) but transfusion requirements were similar. Intraoperative portal vein blood flow measurements averaged 2132 +/- 725 ml/min in the TIPS group compared with 1120 +/- 351 ml/min in the DSRS group (P < 0.001). Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P = 0.1). We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intraoperative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified. SN - 0041-1337 UR - https://www.unboundmedicine.com/medline/citation/7839445/A_comparison_of_treatment_with_transjugular_intrahepatic_portosystemic_shunt_or_distal_splenorenal_shunt_in_the_management_of_variceal_bleeding_prior_to_liver_transplantation_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=7839445.ui DB - PRIME DP - Unbound Medicine ER -