Is the transjugular intrahepatic portocaval shunt procedure beneficial for liver transplant recipients?

Abstract:

:Recent reports document the efficacy of transjugular intrahepatic portocaval shunts (TIPS) for the prevention of portal hypertensive bleeding and have advocated its use as a bridge to liver transplantation. There are no reports, however, analyzing liver transplant results for patients with indwelling TIPS. We reviewed the records of all adult primary recipients with a history of portal hypertensive bleeding or unmanageable ascites transplanted since the TIPS procedure became available in our institution in July 1991. Seven of 20 recipients underwent TIPS before transplant. There were no significant differences between patients with or without TIPS in age, United Network for Organ Sharing status, Child-Pugh score, preoperative prothrombin time, operative time, operative blood product requirement, overall length of stay, and 6-month patient survival after transplant. We noted a trend toward less operative red cell (26.0 +/- 26.2 vs. 31.8 +/- 38.1 U, mean +/- SD) and autologous blood (4,762 +/- 3,335 vs. 13,355 [corrected] +/- 20,460 ml) transfusion and improved patient survival for those with a TIPS. Patients with a TIPS in place waited significantly longer for their transplant (282 +/- 113 vs. 149 +/- 113 days, P = 0.014). There were 2 technical complications related to the TIPS, 1 in a patient who died after rupture of the suprahepatic vena caval anastomosis where the device had traversed the caval/hepatic vein junction and weakened the tissues, and the other in a survivor in whom the device extended into the right atrium and was extracted during the transplant procedure. Three patients with TIPS in place died of sepsis while waiting for a donor organ. We conclude that while the TIPS offers benefits for the liver transplant recipient, placement of the device in small shrunken cirrhotic livers must be precise. Immediate benefits for the transplant candidate may be offset by increased waiting time and technical complications at the transplant operation.

journal_name

Transplantation

journal_title

Transplantation

authors

Freeman RB Jr,FitzMaurice SE,Greenfield AE,Halin N,Haug CE,Rohrer RJ

subject

Has Abstract

pub_date

1994-08-15 00:00:00

pages

297-300

issue

3

eissn

0041-1337

issn

1534-6080

journal_volume

58

pub_type

杂志文章
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  • Rejection of murine cardiac allografts. II. Evidence that splenocytes bearing Lyt2 inhibit responsiveness in long-term heart graft recipients.

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  • A Phase I/II Trial of the Interleukin-6 Receptor-Specific Humanized Monoclonal (Tocilizumab) + Intravenous Immunoglobulin in Difficult to Desensitize Patients.

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    pub_type: 杂志文章

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  • Comparing Glycaemic Benefits of Active Versus Passive Lifestyle Intervention in Kidney Allograft Recipients: A Randomized Controlled Trial.

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    pub_type: 杂志文章,随机对照试验

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    pub_type: 杂志文章

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    pub_type: 杂志文章,评审

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  • A randomized prospective trial of anti-Tac monoclonal antibody in human renal transplantation.

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    journal_title:Transplantation

    pub_type: 临床试验,杂志文章,随机对照试验

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  • Inhibition of leukocyte chemotaxis by immunosuppressive agents. Specific inhibition of lymphocyte chemotaxis by cyclosporine.

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    更新日期:2009-12-27 00:00:00

  • Mannitol infusion within 15 min of cross-clamp improves living donor kidney preservation.

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    pub_type: 杂志文章

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  • Hepatic artery pseudoaneurysm after liver transplantation: treatment with percutaneous thrombin injection.

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  • Humoral antibody responses following transplantation in man.

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    pub_type: 杂志文章

    doi:10.1097/00007890-197503000-00003

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    更新日期:1975-03-01 00:00:00

  • Influence of prophylactic treatment with gamma-immunoglobulins on renal function after kidney transplantation in rhesus monkeys.

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    pub_type: 杂志文章

    doi:10.1097/TP.0b013e31820e0170

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    pub_type: 杂志文章

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    更新日期:1986-01-01 00:00:00

  • Increased infections in liver transplant recipients with recurrent hepatitis C virus hepatitis.

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    pub_type: 杂志文章

    doi:10.1097/00007890-199602150-00014

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    更新日期:1996-02-15 00:00:00

  • Induction of transplantation tolerance in rats by spleen allografts. II. Evidence that W3/25+ T suppressor/inducer and OX8+ T suppressor/effector cells are required to mediate specific unresponsiveness.

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