Results of Liver Transplantation in Patients With Previous Portosystemic Shunts

Gonzalez, Esteban; Planas, J.M. Moreno; Garrido, M C; Poza, José Luis Lucena de la; Arrieta, Felix; Cuervas-Mons, Valentín; Turrión, Víctor Sánchez

doi:10.1016/j.transproceed.2005.02.056

Cited by 7 publications

(5 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,28 However, reduction of intraoperative transfusion of blood products has not shown consistent improved outcomes. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] ►Table 1 demonstrates a limited meta-analysis performed by Saad et al of hospital resource utilization including packed red blood cells in the transplant population. 1 The table demonstrates that from a hospital resource standpoint, there is no significant difference between orthotopic liver transplantations with prior TIPS and orthotopic liver transplants without a prior TIPS (►Table 1).…”

Section: Tips As a Preoperative Prelude To Liver Transplantationmentioning

confidence: 99%

“…This, in theory, may reduce intraoperative bleeding during liver transplantation. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In addition, TIPS creation in liver transplant recipients is another interesting aspect of TIPS. There has been a debate whether or not liver transplantation adds additional technical difficulty to the TIPS procedure; there are several recent studies evaluating the outcomes of TIPS in liver transplant recipients.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Transjugular Intrahepatic Portosystemic Shunt before and after Liver Transplantation

Saad

2014

Semin intervent Radiol

View full text Add to dashboard Cite

The transjugular intrahepatic portosystemic shunt (TIPS) has long been referred to as a procedure performed as ?a bridge to transplantation? since, like many other portosystemic shunts, it decompresses the portal circulation and stabilizes patients but does not definitively treat portal hypertension. One of the major advantages of TIPS over surgically placed portosystemic shunts in the transplant era is that the TIPS is intrahepatic and is removed in situ with the native liver, and usually does not need additional surgery (unlike takedown/ligation of surgical shunts). There are several studies that evaluate TIPS before transplantation?not as a bridge/temporizing measure, but as a prelude to the transplant to decompress the portal circulation and reduce portosystemic engorgement and collaterals and thus, in theory, reduce intraoperative bleeding during liver transplantation. However, these studies, mostly in the transplant literature, have been equivocal from an intraoperative and posttransplant clinical outcome standpoint. TIPS creation in liver transplant recipients is another interesting aspect of TIPS. There has been a debate about whether or not liver transplantation adds additional technical difficulty to the TIPS procedure. Initially, many theories were proposed as to the technical difficulty of TIPS in a transplanted liver. However, recent opinions and published studies demonstrate that whole-graft liver transplantation does not pose a significant technical difficulty to TIPS. Moreover, there are several recent studies evaluating the outcomes of TIPS in liver transplant recipients, showing that outcomes are less favorable when compared with TIPS in nontransplanted patients. This article discusses the results of TIPS as a preoperative prelude to liver transplantation. In addition, it discusses the technical and clinical outcomes of TIPS in liver transplant recipients.

show abstract

Section: Tips As a Preoperative Prelude To Liver Transplantationmentioning

confidence: 99%

mentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt before and after Liver Transplantation

Saad

2014

Semin intervent Radiol

View full text Add to dashboard Cite

show abstract

“…However, the survival rate of the 19 unrandomized patients who underwent LT was 89% after 30 days and 53% after 5 years, which was not significantly different from the survival rates for LT reported by UNOS. PCS did not increase the mortality rate or complications of subsequent LT. Added to the data from our study are at least 10 reports of retrospective studies in the literature that concluded that portosystemic shunts do not affect the results of subsequent LT [5][6][7][43][44][45][46][47][48][49][50][51]. That conclusion has not been contradicted by reported studies.…”

Section: Discussionmentioning

confidence: 52%

Liver Transplantation during Fifty-Three Years’ Experience with Randomized Controlled Trials of Emergency Portacaval Shunt for Bleeding Esophageal Varices in Cirrhosis

Orloff¹

2013

Surgery

View full text Add to dashboard Cite

Background: Currently, emergency treatment of Bleeding Esophageal Varices (BEV) consists mainly of endoscopic and pharmacologic measures, with use of TIPS when bleeding is not controlled. Surgical shunt has been relegated to salvage of survivors of failed endoscopic, pharmacologic, and TIPS treatment. We have conducted 10 prospective studies of Emergency Porta Caval Shunt (EPCS) during 46 years. BEV in cirrhosis has been considered an indication for Liver Transplantation (LT) by some respected LT programs. This important issue was examined in our two recent Randomized Controlled Trials (RCTs) in 365 unselected, consecutive patients with acute BEV conducted from 1988 to 2011. Study design: In RCT No. 1, 211 unselected, consecutive cirrhotic patients with acute BEV ("all comers") were randomized to Emergency Endoscopic Sclerotherapy (EEST) (n=106) or EPCS (n=105). In RCT No. 2, 154 unselected consecutive cirrhotic patients with acute BEV ("all comers") were randomized to TIPS (n=78) or EPCS (n=76). In each RCT, the two treatment groups were compared with regard to effect on survival, control of bleeding, encephalopathy, and direct cost of care. Diagnostic workup was completed within 6 hr and primary treatment was initiated within 8 to 12 hours. Regular follow-up was accomplished in 100% of patients. In RCT No. 1, 96% of patients underwent more than 10 years of follow-up, or until death. In RCT No. 2, follow-up lasted for 5 to 10 years in 85%, and 3 to 4.5 years in the remainder. Patients were evaluated for LT on admission and at regular intervals thereafter. In addition to the two RCTs, the analysis of LT was supplemented in 1300 unrandomized cirrhotic patients who previously underwent Porta Caval Shunt (PCS) with 100% follow-up. Results: Clinical characteristics of each group were similar at the time of enrollment. The distribution of patients in Child risk classes was almost identical in the two groups in each RCT. Almost one-third of patients in each group were in Child class C. Permanent control of bleeding was achieved by sclerotherapy in only 20% and by TIPS in only 22%. In contrast, EPCS permanently controlled bleeding in 97% to 100% (p<0.001). Sclerotherapy and TIPS patients required twice as many units of blood transfusion as EPCS patients. Survival rate at all time intervals and in all Child classes was significantly greater following EPCS than after sclerotherapy and TIPS (p<0.001). Median survival was over 10 years following EPCS, compared to 1.99 years following TIPS. EPCS remained permanently patent in 97% of patients. In contrast, stenosis or occlusion of TIPS was demonstrated in 84% of patients, 63% of whom underwent TIPS revision, which failed in 80%. Recurrent episodes of encephalopathy developed in 35% of sclerotherapy patients and 61% of TIPS patients. In contrast, encephalopathy occurred in 15% of EPCS patients in RCT No. 1 and 21% of EPCS patients in RCT No. 2. Direct costs of care, measured as charges per year, were 5 to 7 times greater in the sclerotherapy group ($168,100) and TIPS groups ($...

show abstract

“…However, the survival rate of the 19 unrandomized patients who underwent LT was 89% after 30 days and 53% after 5 years, which was not significantly different from the survival rates for LT reported by UNOS. PCS did not increase the mortality rate or complications of subsequent LT. Added to the data from our study-are at least 10 reports of retrospective studies in the literature that concluded that portosystemic shunts do not affect the results of subsequent LT [11][12][13][29][30][31][32][33][34][35][36]. That conclusion has not been contradicted by reported studies.…”

Section: Discussionmentioning

confidence: 53%

Liver Transplantation in a Randomized Controlled Trial of Emergency Treatment of Acutely Bleeding Esophageal Varices in Cirrhosis

Orloff

Isenberg

Wheeler

et al. 2010

Transplantation Journal

View full text Add to dashboard Cite

show abstract

Results of Liver Transplantation in Patients With Previous Portosystemic Shunts

Cited by 7 publications

References 8 publications

Transjugular Intrahepatic Portosystemic Shunt before and after Liver Transplantation

Transjugular Intrahepatic Portosystemic Shunt before and after Liver Transplantation

Liver Transplantation during Fifty-Three Years’ Experience with Randomized Controlled Trials of Emergency Portacaval Shunt for Bleeding Esophageal Varices in Cirrhosis

Liver Transplantation in a Randomized Controlled Trial of Emergency Treatment of Acutely Bleeding Esophageal Varices in Cirrhosis

Contact Info

Product

Resources

About