Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation

Azoulay, Daniel; Castaing, Denis; Lemoine, Antoinette; Gm, Hargreaves; Bismuth, H

doi:10.1038/sj.bmt.1702386

Cited by 113 publications

(33 citation statements)

References 24 publications

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“…Osler-Weber-Rendu sindromas 1 (1,9) Vilsono liga 1 (1,9) 3 lentelė. Ultragarso tyrimo duomenys matuojant TIPS veiksmingumą Remiantis nagrinėta literatūra buvo aktualu įvertinti, ar stento disfunkcija sukelia riziką atsirasti pakartotiniam kraujavimui ir refrakteriniam ascitui.…”

Section: Rezultataiunclassified

Ultragarsinio Tyrimo Reikšmė Vertinant Transjugulinio Intrahepatinio Portosisteminio Šunto (Tips) Procedūros Veiksmingumą Ir Komplikacijų Riziką Po Procedūros

Mitraitė

Zibalytė

Strupeikis

et al. 2016

Medicinos Teorija Ir Praktika

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SANTRAUKA Reikšminiai žodžiai: transjugulinis intrahepatinis portosisteminis šuntas (TIPS), portinė hipertenzija (PH), hepatinių venų spaudimo gradientas (HVPG), ultragarsinis tyrimas (UG).Spalvinio doplerio tyrimu diagnozuojama portinė hipertenzija, kuri išsivysto kaip komplikacija sergant kepenų ciroze. Transjugulinis intrahepatinis portosisteminis šuntas (TIPS) yra angiografinio pobūdžio gydymo metodas, kuriuo siekiama sumažinti portinę hipertenziją ir jos komplikacijas (refrakterinį ascitą, varikozinių venų pakartotinį kraujavimą). Neretai ši intervencinė procedūra yra "tiltas" iki kepenų transplantacijos žmonėms, sergantiems sunkios stadijos kepenų liga. Tikslas. Įvertinti doplerio efektu pagrįstų ultragarsinių parametrų ryšį su TIPS procedūros veiksmingumu ir komplikacijų rizika. Tyrimo medžiaga ir metodai. Atliktas retrospektyvinis ir iš dalies prospektyvinis tyrimas, kurio metu išnagrinėtos 45 pacientų epikrizės ir 7 pacientai pakartotinai ištirti ultragarsu. Visiems pacientams Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (LSMUL KK) Gastroenterologijos skyriuje 2004-2013 m. atlikta TIPS procedūra. Tyrimo metu vertinti duomenys: lytis, amžius, v. portae diametras (cm), v. portae kraujotakos greitis prieš TIPS ir po TIPS (m/s), hepatinių venų spaudimo gradientas prieš ir po TIPS (mmHg), pagrindinės ligos diagnozė, pasireiškusių komplikacijų atvejai. Duomenų analizė atlikta SPSS 17.0 programa. Požymių priklausomybei ir ryšio stiprumui vertinti skaičiuotas chi kvadrato (χ2) kriterijus ir Spearmano koreliacijos koeficientas (r). Varikozinių venų pakartotinis kraujavimas atsirado 9 pacientams (17,3 proc.), nebuvo 43 pacientams (82,7 proc). Refrakterinio ascito dinamika prieš ir po intervencijos: sumažėjo 35 pacientams (67,3 proc.), nesumažėjo 17 pacientų (32,7 proc.). Tarp komplikacijų pasireiškė: hepatinė encefalopatija (60,7 proc.), stento disfunkcija (39,3 proc.), hemolizinė anemija (14,3 proc.). Išvados. Remiantis atlikto tyrimo skaičiavimų duomenimis, rezultatai rodo, kad TIPS yra veiksmingas gydant portinę hipertenziją ir jos sukeliamas komplikacijas. Spalvinis dopleris yra neinvazinis, greitai atliekamas, nebrangus ir informatyvus tyrimas, padedantis nustatyti TIPS veiksmingumą. ABSTRACTKey words: transjugular intrahepatic portosystemic shunt (TIPS), portal hypertension (PH), hepatic venous pressure gradient (HVPG), doppler ultrasonography (DUS). Paula Zibalytė Lietuvos sveikatos mokslų universiteto Medicinos akademijos Medicinos fakultetas Eivenių g. 2, Kaunas

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Section: Rezultataiunclassified

Ultragarsinio Tyrimo Reikšmė Vertinant Transjugulinio Intrahepatinio Portosisteminio Šunto (Tips) Procedūros Veiksmingumą Ir Komplikacijų Riziką Po Procedūros

Mitraitė

Zibalytė

Strupeikis

et al. 2016

Medicinos Teorija Ir Praktika

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“…Unfortunately, all but three died of other complications. There is some suggestion from the report of Azoulay and colleagues, 79 that responding patients have less severe disease, as demonstrated by lower bilirubin and ALT prior to the TIPS and a greater reduction in the hepatic venous pressure gradient after the procedure. In addition, their patients who died shortly after TIPS had a shorter interval from transplant to TIPS than patients who survived more than 10 days, suggesting that the pace of their disease was faster.…”

Section: Non-pharmacologic Therapy: Transjugular Intrahepatic Portosymentioning

confidence: 99%

“…A total of 19 patients have been reported in the literature. [76][77][78][79] Significant reduction in hepatic venous pressure gradient was reported after the procedure. Eight patients had no improvement in VOD and died within 2 weeks.…”

Section: Non-pharmacologic Therapy: Transjugular Intrahepatic Portosymentioning

confidence: 99%

Avoiding hepatic veno-occlusive disease: what do we know and where are we going?

Bearman

2001

Bone Marrow Transplant

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Summary:Hepatic venocclusive disease (V0D) is a common toxicity associated with myeloablative chemotherapy or chemoradiotherapy used to prepare patients for stem cell transplantation. A sizable proportion of patients who develop VOD die. It is clear that injury to endothelial cells and hepatocytes in zone 3 of the liver acinus is the initial event in the pathogenesis of VOD. What are less clear are the mechanisms of injury and whether this knowledge can be exploited. This manuscript will briefly review some recent data and discuss how that information has influenced clinical practice. Bone Marrow Transplantation (2001) 27, 1113-1120. Keywords: veno-occlusive disease; stem cell transplantation; toxicity VOD is characterized by a syndrome of jaundice, fluid retention and painful hepatomegaly and occurs in up to half of patients who receive ablative preparative therapy. 1 As many as half of patients with VOD die, usually of multiorgan failure. Signs of VOD usually present around the day of transplant, 2 although well described 'late onset VOD' has been reported. 3,4 Fluid retention and hepatomegaly are usually the first manifestations and typically present on or around the day of transplant. Jaundice develops later, around day 6. 2 The rate of rise in bilirubin and weight is also faster for patients whose illness is likely to be severe vs those who are likely to have self-limited disease. Furthermore, fewer than 20% of patients with mild VOD and 48% with severe VOD develop ascites. 2 These observations led to the development of a model p ϭ 1/(1 ϩ e Ϫz ) which would predict which patients with VOD were likely to die. 5 In this model, z ϭ ␤ 0 ϩ ␤ 1 (in total serum bilirubin) ϩ ␤ 2 (percent weight gain). The intercepts ␤ 0 , ␤ 1 and ␤ 2 change as day relative to transplant increases. 5 For

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“…59 It was reported that IL-1, TNFalpha, interferon gamma, IL-2 receptor-alpha and TNF-receptor levels increased in ES as in acute International Journal of Hematology and Oncology GVHD. 54 Soluble thrombomodulin and plasminogen activator type I, CRP increase and complement activation are changes detected in ES. 60 The incidence of ES is varying from 5% to 72% because the definition and criteria of ES are not described precisely.…”

Section: Engraftment Syndromementioning

confidence: 99%

“…33 Transjugular intrahepatic portosystemic shunt can be performed in patients who are unsuitable for surgery. 54 In advanced liver failure, liver transplantation can be a treatment option in few cases. …”

mentioning

confidence: 99%

Non-Infectious Early Complications of Allogeneic Stem Cell Transplantations

Demirer¹

2016

UHOD

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Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is the only curative option in many benign and malign hematological disorders. Recent developments in posttransplant supportive care, graft versus host disease (GVHD) prophylaxis and treatment as well as reduced intensity conditioning regimens (RIC) have improved posttransplant survival. However, infections, GVHD related organ injury, increased incidence of human leukocyte antigen (HLA) mismatched unrelated or haploidentical transplantations effect posttransplant mortality in a negative manner. Allo-HSCT related complications can be classified into early (within 3 months of transplantation) and long term complications (after 3 months of transplantation). Some early complications which will be briefly discussed in this review are graft failure, sinusoidal obstruction syndrome, capillary leak syndrome, engraftment syndrome, diffuse alveolar hemorrhage and thrombotic microangiopathy.

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Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation

Cited by 113 publications

References 24 publications

Ultragarsinio Tyrimo Reikšmė Vertinant Transjugulinio Intrahepatinio Portosisteminio Šunto (Tips) Procedūros Veiksmingumą Ir Komplikacijų Riziką Po Procedūros

Ultragarsinio Tyrimo Reikšmė Vertinant Transjugulinio Intrahepatinio Portosisteminio Šunto (Tips) Procedūros Veiksmingumą Ir Komplikacijų Riziką Po Procedūros

Avoiding hepatic veno-occlusive disease: what do we know and where are we going?

Non-Infectious Early Complications of Allogeneic Stem Cell Transplantations

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