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Title: $Transjugular intrahepatic portosystemic shunt and liver transplantation
Abstract: ObjectiveIn patients with intractable esophageal variceal bleeding, transjugular intrahepatic portosystemic shunt (TIPSS) is being used increasingly as a bridge to orthotopic liver transplantation (OLTx). There is little information in the literature concerning variations in the operative techniques of OLTx required because of the presence of TIPSS. MethodsA retrospective analysis of patients treated by TIPSS prior to OLTx was conducted. The aims were to assess the effectiveness of TIPSS in bridging patients to OLTx and to examine whether TIPSS influence the operative management of OLTx. ResultsFive adult patients underwent TIPSS insertion prior to OLTx in Pittsburgh. Transplantation was performed at a mean of 9.6 (0.2~24.7) months after TIPSS insertion. Prevention of major recurrent variceal hemorrhage prior to transplantation was achieved in 3 cases. In four patients, the stent extended into the portal vein, requiring removal during OLTx by division of the stent with the recipient's portal vein. All patents were alive at a mean of 4.2 (2~7) months post-transplantation and none of them had portal vein thrombosis. There was no difference in the length of operating time. ConclusionsTIPSS offers a bridge to OLTx by providing effective control of variceal hemorrhage. In the present series, TIPSS does not increase surgical morbidity or mortality. However, emphasis should be placed upon the need for optimal TIPSS placement within the liver to facilitate subsequent OLTx.