COMPARISON OF TRANSJUGULAR AND SURGICAL PORTOSYSTEMIC SHUNTS ON THE OUTCOME OF LIVER-TRANSPLANTATION

Objective: To analyze the effect of previous transjugular intrahepatic portosystemic shunt (TIPS) vs surgical portosystemic shunt (SPS) on t he outcome of orthotopic liver transplantation (OLT). Design: A case s eries of 38 patients who underwent OLT: 25 with a previous TIPS and 13 with a previous SPS. Setting: A liver transplant center and intervent ional radiology service in a private, tertiary referral medical center . Patients: Eighteen men and seven women who had a TIPS before OLT wer e compared with nine men and four women who had an SPS before OLT. Mai n Outcome Measures: Operative transfusion requirements, operative time , length of hospital stay, postoperative liver chemistry studies, and graft and patient survival. Results: Compared with patients who had an SPS, patients who had a TIPS had significantly less median transfusio n requirements for packed red blood cells (5 vs 12 U), fresh-frozen pl asma (0 vs 8 U), and thrombocytes (0 vs 1 U). The median operative tim e (9 vs 13 hours), length of intensive care unit stay (3 vs 5 days), a nd length of hospital stay (12 vs 24 days) were also significantly les s in patients who had a TIPS, The 2-year actuarial patient survival ra te was 92% in both groups. Conclusions: In patients undergoing OLT, TI PS is associated with reduced operative transfusion requirements, oper ative time, and length of intensive care unit and hospital stays compa red with SPS. In the potential liver transplant candidate with refract ory complications of portal hypertension, TIPS is preferred to SPS.