BILE-DUCT INJURY AS A MAJOR CAUSE OF STENOSIS AND OCCLUSION IN TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS - COMPARATIVE HISTOPATHOLOGICANALYSIS IN HUMANS AND SWINE

PURPOSE: A comparative histologic analysis of human and swine transjug ular intrahepatic portosystemic shunts (TIPS) was performed to investi gate factors limiting TIPS patency and to further develop an animal mo del for TIPS. MATERIALS AND METHODS: Twenty-one human and 13 porcine s hunts were evaluated by means of gross inspection, histologic evaluati on, and electron microscopy. RESULTS: Severe stenosis (>75% narrowing) or occlusion was detected with portal venography in nine of the 21 hu man shunts (48%) and in 10 of 13 porcine shunts (77%). Gross or histol ogic evidence of a substantial biliary fistula was observed in seven o f nine porcine shunts and in seven of eight human shunts with severe p arenchymal tract stenosis or occlusion. No evidence of substantial bil e duct injury was identified in the 13 human shunts or two swine shunt s with patent, nonstenotic parenchymal tracts (P < .01, Fisher exact). Histologic findings in porcine shunts mimicked human tissue responses , including a metaplastic proliferation of bile duct epithelium at sit es of bile duct transection. CONCLUSION: Bile duct transection and bil e leak are significantly associated with TIPS parenchymal tract abnorm alities in patients and swine. TIPS in swine created with the Wallsten t faithfully reproduce gross morphologic and histologic changes observ ed in patients.