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Transplant Rev (Orlando). 2019 Apr;33(2):64-71. doi: 10.1016/j.trre.2018.10.004. Epub 2018 Oct 31.

Transjugular intrahepatic portosystemic shunt as a bridge to liver transplant: Current state and future directions.

Author information

1
Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States. Electronic address: cortlandt.sellers@yale.edu.
2
Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States. Electronic address: nariman.nezami@yale.edu.
3
Division of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Section of Transplantation and Immunology, Department of Surgery, Yale School of Medicine, New Haven, CT,United States. Electronic address: michael.schilsky@yale.edu.
4
Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States; Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Yale Cancer Center, Yale School of Medicine, New Haven, CT, United States. Electronic address: kevin.kim@yale.edu.

Abstract

Liver transplantation is one of the mainstays of treatment for liver failure due to severe chronic liver disease. Bridging therapies, such as placement of a transjugular intrahepatic portosystemic shunt (TIPS), are frequently employed to control complications of portal hypertension such as ascites, hydrothorax, and variceal bleeding, and thereby reduce morbidity in patients awaiting transplant. There is no significant difference seen in either graft survival or patient survival between those receiving TIPS pre-transplant and those who do not, although those receiving TIPS placement on average have a longer waiting time on the transplant waitlist. Locoregional therapies, such as thermal ablation or chemoembolization, can be efficacious in patients with HCC and pre-existing TIPS; however there is a risk for increased adverse events in patients receiving these therapies who have TIPS compared to those who do not. In summary, TIPS is a safe, effective treatment that can be used to ameliorate the complications that are sequelae of portal hypertension. While it does not appear to improve survival post-transplant, TIPS placement pre-transplant may increase survival time to transplant, thus improving overall survival as well as quality of life.

KEYWORDS:

Ascites; Hepatocellular carcinoma; Liver transplantation; Portal hypertension; Transjugular intrahepatic portosystemic shunt; Variceal bleeding

PMID:
30477811
DOI:
10.1016/j.trre.2018.10.004

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