Pretransplant Portal Vein Recanalization—Transjugular Intrahepatic Portosystemic Shunt in Patients With Complete Obliterative Portal Vein Thrombosis

Salem, Riad; Vouche, Michaël; Baker, Talia; Herrero, J.I.; Caicedo, Juan C.; Fryer, Jonathan P.; Hickey, Ryan; Habib, Ali; Abecassis, Michael; Koller, Felicitas L.; Vogelzang, Robert L.; Desai, Kush; Thornburg, Bartley; Hohlastos, Elias; Resnick, Scott A.; Lewandowski, Robert J.; Sato, Kent T.; Ryu, Robert K.; Ganger, Daniel; Kulik, Laura

doi:10.1097/tp.0000000000000729

Cited by 127 publications

(111 citation statements)

References 22 publications

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“…In about 28% of LT patients TIPS had migrated, increasing the time spent on by pass and complexity of transplant operation. The presence of TIPS however does not have any influence on intra-operative blood requirements, length of hospital stay or early survival after LT [115,196,199,202,203,207]. No significant advantage in performing TIPS before living donor liver transplantation has been observed [125].…”

Section: Session 5: Tips In Liver Transplant Settingmentioning

confidence: 99%

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Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

130

120

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a b s t r a c tThe trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty. On this basis, the Italian Association of the Study of the Liver (AISF), the Italian College of Interventional Radiology-Italian Society of Medical Radiology (ICIR-SIRM), and the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) promoted a Consensus Conference on TIPS. Under the auspices of the three scientific societies, the consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Bergamo on June 4th and 5th, 2015. The final statements presented here were graded according to quality of evidence and strength of recommendations and were approved by an independent jury. By highlighting strengths and weaknesses of current indications to TIPS, the recommendations of AISF-ICIR-SIRM-SIAARTI may represent the starting point for further studies.

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Section: Session 5: Tips In Liver Transplant Settingmentioning

confidence: 99%

“…gastrointestinal bleeding or refractory ascites), but also related to the patient's priority in the waiting list due to MELD score modifications [10,11,196,197,199,[201][202][203]. [115,196,199,202,203,207].…”

Section: Session 5: Tips In Liver Transplant Settingmentioning

confidence: 99%

Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

130

120

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“…Once TIPS can be placed, the recanalization rate is excellent (up to 80% partially or completely restored patency) [43]. This effect is possibly independent of anticoagulation [43,57]. In one study, residual thrombus was present in 77% of cases after TIPS placement, while, 1 month after the TIPS procedure, 76% of cases had complete resolution of thrombus.…”

Section: Managementmentioning

confidence: 99%

Portal vein thrombosis in patients with cirrhosis

Köckritz

Gottardi

Trebicka

et al. 2017

Gastroenterology Report

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Portal vein thrombosis (PVT) is frequent in patients with liver cirrhosis and possible severe complications such as mesenteric ischemia are rare, but can be life-threatening. However, different aspects of clinical relevance, diagnosis and management of PVT are still areas of uncertainty and investigation in international guidelines. In this article, we elaborate on PVT classification, geographical differences in clinical presentation and standards of diagnosis, and briefly on the current pathophysiological understanding and risk factors. This review considers and highlights the pitfalls of the various treatment approaches and prophylactic treatments. Finally, we review the controversial issue of clinical impact of PVT on prognosis, especially considering liver transplantation and future perspectives.

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“…TIPS is now indicated in cirrhosis for severe acute variceal bleeding (“early TIPS” strategy) and uncontrollable/recurrent variceal bleeding (“rescue TIPS” strategy) . Some reports exist on recanalization of PVTs (including some cases with total obliterative PVT) using a transsplenic approach, allowing liver transplantation with a physiological anastomosis when necessary although PVT has been considered a relative contraindication in the past. Notably, PVT can impair TIPS implantation and in the case of variceal bleeding, new interventional radiological techniques such as percutaneous retroperitoneal splenorenal shunt (PRESS) or direct intrahepatic portocaval shunt have been described as salvage therapy, although the longterm outcomes still need to be defined .…”

Section: Pretransplant Indications For Tips Implantationmentioning

confidence: 99%

Management of portal hypertension before and after liver transplantation

Unger¹,

Berlakovich²,

Trauner

et al. 2017

Liver Transpl

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Orthotopic liver transplantation (OLT) represents a curative treatment option for end-stage liver disease (ESLD). Although epidemiology of ESLD has recently changed due to the rising prevalence of nonalcoholic fatty liver disease and the decreased burden of hepatitis C virus infections due to highly effective antiviral regimens, the management of portal hypertension (PHT) remains a clinical challenge in the pre-and post-OLT setting. The measurement of the hepatic venous pressure gradient represents the most reliable but invasive tool for assessment of the severity of PHT. Although novel liver ultrasound and magnetic resonance-based elastography methods have been developed, their value to screen for liver fibrosis and PHT in transplanted patients remains to be established. Nonselective beta-blockers represent the cornerstone of medical treatment of PHT, but more studies on their effects on clinical endpoints after OLT are needed. Statins are widely used to treat hyperlipidemia, which is a common condition after OLT. Although a growing body of evidence suggests that statins decrease portal pressure and PHTrelated complications in ESLD, studies on potential benefits of statins after OLT are lacking. Finally, transjugular intrahepatic portosystemic shunts (TIPS) are effective in decreasing PHT and seem to decrease mortality on the OLT waiting list. Moreover, TIPS does not have an impact on liver function nor complicate the transplant surgical procedures. TIPS may also be used after OLT, but the evidence is limited. In conclusion, whereas the management of PHT in patients with ESLD is based on strong evidence, further data on the value of noninvasive monitoring tools as well as on medical and invasive treatment options in the post-OLT setting are needed to improve management strategies in patients with recurrent PHT after liver transplantation.

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Pretransplant Portal Vein Recanalization—Transjugular Intrahepatic Portosystemic Shunt in Patients With Complete Obliterative Portal Vein Thrombosis

Abstract: The PVR-TIPS may be considered for patients with obliterative PVT who are otherwise appropriate candidates for LT. The high rate of MPV patency post-TIPS placement suggests flow reestablishment as the dominant mechanism of thrombus resolution.

Cited by 127 publications

References 22 publications

Consensus conference on TIPS management: Techniques, indications, contraindications

Consensus conference on TIPS management: Techniques, indications, contraindications

Portal vein thrombosis in patients with cirrhosis

Management of portal hypertension before and after liver transplantation

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