TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT CREATION IN CHILDREN - INITIAL CLINICAL-EXPERIENCE

PURPOSE: To assess an initial clinical experience with the creation of a transjugular intrahepatic portosystemic shunt (TIPS) in children. M ATERIALS AND METHODS: Twelve consecutive patients with complications o f portal hypertension underwent TIPS creation at out institution betwe en July 1993 and September 1996. There were six boys and six girls age d 2 years 5 months to 16 years 10 months (median, 9 years 2 months) wh o weighed 13.9-80.9kg (median, 27.65kg). A standard radiographic techn ique was used. RESULTS: Thirteen procedures were performed to achieve 12 successful TIPS creations. One child with a reduced-size liver tran splant had to undergo two procedures for a successful TIPS creation. N o major procedural complications or morbidity occurred. In 10 children , TIPS patency was documented by means of pathologic inspection at ort hotopic liver transplantation (median shunt duration, 53 days). Shunt stenosis developed in one child at 186 days but was treated successful ly. Two children had functional shunts at 301 and 357 days, respective ly. No episodes of repeat variceal hemorrhage were noted. One child de veloped postprocedural encephalopathy, which responded to medical ther apy. CONCLUSION: This initial experience suggests that TIPS creation i s technically feasible and is as safe in children as in adults. TIPS c reation can aid in the management of portal hypertension in children, especially in those needing temporary relief before liver transplantat ion.