Role of TIPS as a bridge to hepatic transplantation in Budd-Chiari syndrome

PURPOSE: To investigate the role of transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to transplantation for patients with Budd-Chiari syndrome (BCS), MATERIALS AND METHODS: Eight patients (five women, three men) with a mean a ge of 49.8 years (range, 20-61 years) were diagnosed with BCS by means of c omputed tomography, hepatic venography, and liver biopsy. One patient had a cute liver failure, with subacute or chronic failure in seven. TIPS placeme nt was attempted in all eight patients, Clinical follow-up and portograms w ere obtained in all patients until death or transplantation. RESULTS: TIPS placement was completed in seven of eight patients (87.5%). D uring the follow-up period, TIPS occlusion occurred in four patients. TIPS revision in this patient, although successful, was complicated by hemorrhag e and multiorgan failure, and the patient died. Assisted patency rate, excl uding the technical failure, was 100%. Mean follow-up in the six survivors with TIPS was 342 days (range, 19-660 days). All six survivors had complete resolution of their ascites, Albumin levels improved an average of 0.43 g/ dL (range, 0.3-1.4 g/dL), Bilirubin levels improved in five of six patients (83%), decreasing by an average of 5.6 mg/dL (range, 3.0-15.2 mg/dL), Of t he six survivors, three underwent elective liver transplantation, one is aw aiting transplantation, and one has been removed from the transplantation l ist because of clinical improvement. One patient was a candidate for transp lantation but declined to be put on the list. CONCLUSION: Hepatic synthetic dysfunction improves markedly after TIPS plac ement in patients with BCS, Significant improvement in ascites can also occ ur. TIPS can be an effective bridge to transplantation for patients with BC S.