Comparison of transjugular and surgical portosystemic shunts on the outcome of liver transplantation
F. Menegaux, E. B. Keeffe, E. Baker, H. Egawa, W. Concepcion, T. R. Russell and C. O. Esquivel
Department of Transplantation, California Pacific Medical Center, San Francisco.
OBJECTIVE: To analyze the effect of previous transjugular intrahepatic
portosystemic shunt (TIPS) vs surgical portosystemic shunt (SPS) on the
outcome of orthotopic liver transplantation (OLT). DESIGN: A case series of
38 patients who underwent OLT: 25 with a previous TIPS and 13 with a
previous SPS. SETTING: A liver transplant center and interventional
radiology service in a private, tertiary referral medical center. PATIENTS:
Eighteen men and seven women who had a TIPS before OLT were compared with
nine men and four women who had an SPS before OLT. MAIN 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 transfusion requirements for packed
red blood cells (5 vs 12 U), fresh-frozen plasma (0 vs 8 U), and
thrombocytes (0 vs 1 U). The median operative time (9 vs 13 hours), length
of intensive care unit stay (3 vs 5 days), and length of hospital stay (12
vs 24 days) were also significantly less in patients who had a TIPS. The
2-year actuarial patient survival rate was 92% in both groups. CONCLUSIONS:
In patients undergoing OLT, TIPS is associated with reduced operative
transfusion requirements, operative time, and length of intensive care unit
and hospital stays compared with SPS. In the potential liver transplant
candidate with refractory complications of portal hypertension, TIPS is
preferred to SPS.
