Two-Stage Transjugular Intrahepatic Porta-Systemic Shunt for Patients With Cirrhosis and a High Risk of Portal-Systemic Encephalopathy Patients as a Bridge to Orthotopic Liver Transplantation: A Preliminary Report

• Published in: Transplantation proceedings Vol. 38; no. 1; pp. 204 - 208
• Main Authors: Wróblewski, T., Rowiński, O., Ziarkiewicz-Wróblewska, B., Górnicka, B., Albrecht, J., Jones, E.A., Krawczyk, M.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 2006; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Esophageal and Gastric Varices - surgery; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatic Encephalopathy - epidemiology; Hepatic Encephalopathy - prevention & control; Humans; Liver Cirrhosis - surgery; Liver Transplantation; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Portasystemic Shunt, Transjugular Intrahepatic - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; High risk; Hepatic disease; Systemic; Homotransplantation; Portal systemic; Orthotopic transplantation; Surgery; Encephalopathy; Stage; Graft; Disseminated; Intrahepatic; Human; Jugular vein; Transjugular route; Nervous system diseases; Shunt; Report; Patient; Cerebral disorder; Medicine; Bridges; Cirrhosis; Clinical stage; Treatment; Central nervous system disease; Digestive diseases
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.12.019

Placement of a transjugular intrahepatic porta-systemic shunt (TIPS) is a therapeutic option for the management of bleeding esophageal varices. However, the procedure is associated with an increased risk of portal-systemic encephalopathy (PSE). In this study, a two-stage modification of the standard TIPS technique was introduced for the management of variceal bleeding in cirrhotic patients with a high risk of PSE before liver transplantation. The modified procedure was applied to four patients with cirrhosis, portal hypertension, and ascites. Two had a history of encephalopathy after variceal bleeding; the other two were encephalopathic at the time of the first stage of the modified procedure. In the first stage, a 6-mm diameter intrahepatic shunt was created using a Palmaz-Schatz stent. One month later, in the second stage, the lumen of the shunt was expanded to a diameter of 10 mm. Both stages of this TIPS procedure were undertaken without any associated adverse events. In particular, neither stage was followed by a deterioration of neurologic status. From completion of the second stage to undertaking orthotopic liver transplantation (a period of 2 to 6 months), no rebleeding from esophageal varices occurred. A two-stage TIPS procedure to reduce portal hypertension enables a more gradual adaptation to post-TIPS hemodynamic and metabolic changes than occurs after creation of a conventional TIPS. A two-stage TIPS procedure may be the method of choice for treating bleeding from esophageal varices in patients who have a high risk of developing PSE and give them a chance for liver transplantation.