Portal Vein Recanalization-Transjugular Intrahepatic Portosystemic Shunt (PVR-TIPS) in patients with anatomical portal contraindication to liver transplantation: feasibility and clinical implication

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2025-02-01 DOI:10.1016/j.dld.2025.01.090

C. Becchetti , G. Perricone , E. Motto , F. Bolis , F. Barbosa , A. Alfonsi , F. Morelli , L. Centonze , R. De Carlis , E. Roselli , A. Vanzulli , G. Monti , L.S. Belli , A. Airoldi , L. De Carlis , A. Lauterio , Marco Solcia

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引用次数: 0

Abstract

Introduction

Portal vein thrombosis (PVT) may represent a relative contraindication to liver transplantation (LT). Transjugular intrahepatic portosystemic shunt (TIPS), a procedure intended to treat complications of portal hypertension, may allow portal vein (PV) recanalization (PVR).

Aim

We describe our single-center experience with PVR-TIPS in patients who are clinically candidates for LT but contraindicated because of PV anatomy.

Methods

We included consecutive patients who underwent PVT-TIPS at our center from February 2014 to May 2023. Patients with previous LT or vascular liver disease were excluded. Clinical variables at TIPS placement and LT were collected.

Results

We found 25 patients (19 males [76%], mean age 56 years [IQR 51-62]) in whom PVR-TIPS was offered for considering LT otherwise contraindicated because of PV anatomy. Twelve (48%) patients showed main PV thrombosis (PVT), 8 (32%) had cavernoma and 5 (20%) had PV with very small diameter. The main indication for LT was hepatocellular carcinoma (HCC) (10 patients, 40%), with 8 patients (32%) having active HCC at the time of PVR-TIPS. PVR-TIPS was successfully achieved in all but one patient. Concurrently, 9 patients (38%) underwent endovascular closure of porto-systemic shunts. All patients were listed post-PVR-TIPS with MELD at listing higher than pre-PVR-TIPS MELD (16±3 vs. 21±6, p<0.001). Overall, 3 patients (12%) were delisted due to improvement in clinical status, 2 (8%) died on the waiting list, 14 (56%) underwent LT, while 5 (21%) are still on WL. LT was technically feasible with standard PV anastomosis. One patient died 141 days after LT due to endocarditis, while another was successfully retransplanted due to primary graft dysfunction.

Conclusions

PVR-TIPS may be a strategy to allow LT in patients otherwise excluded due to PV anatomy. It requires a high level of technical expertise and is often associated with a deterioration of liver function.

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.