Transjugular intrahepatic portosystemic shunt after adult liver transplantation - Experience in eight patients

Background. Transjugular intrahepatic portosystemic shunting (TIPS) has bec ome an effective treatment for the complications of portal hypertension. We assessed the feasibility and outcome of TIPS in liver transplant recipient s, Methods. During the period from December 1992 to January 1998, eight adults presenting recurrent hepatitis C virus (five patients) and hepatitis B vir us (one patient) infection, veno-occlusive disease (one patient), and secon dary biliary cirrhosis (one patient) had TIPS because of refractory ascites (five patients), bleeding esophageal varices (one patient), refractory hep atic hydrothorax (one patient), retransplantation (two patients), and redo- biliary surgery (one patient). Results, In two patients, the procedure was difficult due to cavo-caval imp lantation. Ascites, hydrothorax, and variceal bleeding were controlled in a ll patients, Moderate to severe encephalopathy developed in four patients; two patients had worsening of their existing encephalopathy, Three of five patients treated with cyclosporine needed a drastic dose reduction due to t he development of severe side effects, No long-term survivor developed shun t stenosis or occlusion, Two patients did moderately well at 6 and 14 month s, respectively; the former died due to chronic rejection while waiting for a retransplantation, Three did well at 14, 36, and 28 months, respectively ; the latter patient died of liver failure 32 months after TIPS, One jaundi ced patient died after 1.5 months due to necrotic pancreatitis, Two patient s died after 4 and 8.5 months, respectively, due to liver failure; the latt er was doing well until 7 months after TIPS. Conclusions, TIPS is feasible in transplant recipients in cases of decompen sated allograft cirrhosis, of allograft veno-occlusive disease or when retr ansplantation or redo-biliary surgery are scheduled in the presence of port al hypertension, At transplantation, the surgeon should keep in mind the ev entuality of a later TIPS procedure, Close immunosuppression monitoring is warranted because modified metabolization of cyclosporine (and probably tac rolimus) may cause serious side effects.