Expanding the use of transjugular intrahepatic... : Liver Transplantation (original) (raw)
Liver Transplantation Worldwide: PDF Only
Expanding the use of transjugular intrahepatic portosystemic shunts for veno-occlusive disease
1Gastroenterology/Hepatology Section, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, 1100 Fairview Ave N Seattle, WA 98109-1024
Abstract
Severe veno-occlusive disease (VOD) of the liver is a leading cause of mortality after bone marrow transplantation (BMT). Vascular and parenchymal injuries account for acute portal hypertension and liver failure is frequently present. We describe the results of transjugular intrahepatic portosystemic shunt (TIPS) for the management of VOD after BMT. TIPS was performed in 10 patients with histologically proven severe VOD. Portal hypertension was controlled by TIPS in all patients (mean hepatic venous pressure gradient before, 20 ± 11 vs 6 ± 5 mm Hg after TIPS, P < 0.01) without technical complications. Five patients with rapidly worsening VOD died within 10 days of TIPS without any improvement. The five remaining patients with less advanced disease showed improvement in various clinical and biological parameters. Four patients subsequently died. The lone survivor continues to do well with resolution of VOD 6 months after TIPS. TIPS can be performed safely and controls portal hypertension in VOD after BMT. Arguments from the present series and from eight previously reported cases favour earlier application of TIPS to obtain improved overall survival.
Copyright © 2001 American Association for the Study of Liver Diseases.