Transjugular Intrahepatic Portosystemic Shunt in patients after orthotopic liver transplantation (OLTx) due to life threatening gastrointestinal hemorrhage. A single-center experience based on three cases and literature review

Abstract

Background: Transjugular intrahepatic portosystemic shunt system (TIPS) is a well-recognized method of treatment of symptomatic portal hypertension in patients awaiting liver transplantation. Effectiveness of the TIPS treatment in patients after liver transplantation is still not fully established. Indications for both groups of patients, with and without liver graft, are similar and include bleeding from gastrointestinal varices, ascites, pleural effusion and Budd-Chiari syndrome. Feasibility of TIPS in emergency treatment in patients after OLTx due to life threatening hemorrhage is not well described. Materials and methods: Patients after OLTx performed using classical, non piggy-back technique had severe hemorrhages from gastrointestinal varices due to loss of grafts function. Patients were in an unstable condition, required blood transfusions on admittance and monitoring in Intensive Care Unit. TIPS were implanted urgently, after unsuccessful endoscopic treatment, as a life-saving procedure. Results: In all cases procedure was successfully completed. The bleeding did not reoccur during postoperative course. Conclusion: TIPS procedure appears to be justified, as a bridge to a planned retransplantation, or as a treatment of choice in patients disqualified from re-transplantation. Emergency performance of the TIPS procedure, as a treatment for acute variceal bleeding should still be considered individually for each patient and only as a procedure leading to further treatment.