Transjugular intrahepatic portosystemic shunts

Abstract

TO THE EDITORS:We read with great interest King et al.'s article entitled ''A Case-Controlled Study of the Safety and Efficacy of Transjugular Intrahepatic Portosystemic Shunts After Liver Transplantation.'' 1 We published the outcomes for 26 patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement for intractable ascites after liver transplantation. 2 We also found that a Model for End-Stage Liver Disease score less than 15 predicted prolonged survival after TIPS placement in liver transplant recipients. Our experience remains the largest documented experience in the English literature. Eighty-eight percent of our patients were infected with hepatitis C virus. Only 37% were biopsy-proven to have cirrhosis. The technical success rate was 100%. The primary patency rate was 81%. Fifty-seven percent of the procedures were considered clinically successful. Fifty percent of the patients were alive at 1 year. We are gratified that King et al.'s case-controlled trial has validated our results. We believe that TIPS placement is an important intervention for patients with refractory ascites after liver transplantation.So that we could analyze a uniform cohort, we excluded 4 TIPS procedures performed for variceal bleeding after transplantation. At this point, we believe that TIPS placement for variceal bleeding is understudied. There are not enough patients in this publication (or in our experience) to make cogent and defensible conclusions. We look forward to the prospective collection of data for these procedures, and we hope that this will provide support for this intervention in these complex patients.