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Fabrice Menegaux, MD; Emmet B. Keeffe, MD; Edward Baker, MD; Hiroto Egawa, MD; Waldo Concepcion, MD; Thomas R. Russell, MD; Carlos O. Esquivel, MD, PhD

Arch Surg. 1994;129(10):1018-1024.

Abstract
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 1U). 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.

(Arch Surg. 1994;129:1018-1024)

Author Affiliations
From the Departments of Transplantation (Drs Menegaux, Keeffe, Egawa, Concepcion, and Esquivel), Radiology (Dr Baker), and Surgery (Dr Russell), California Pacific Medical Center, San Francisco.

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