Transjugular intrahepatic portosystemic shunt in liver transplant recipients
Transjugular intrahepatic portosystemic shunt in liver transplant recipients
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DOI：
10.3748/wjg.15.1999
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发表时间：
2009-04-28
影响因子：
4.3
通讯作者：
Vogel, Wolfgang
中科院分区：
文献类型：
--
作者：
Finkenstedt, Armin;Graziadei, Ivo W.;Vogel, Wolfgang
目的：目的：探讨肝移植术后经颈静脉肝内门体分流术（TIPS）的疗效。方法：1996年11月至2005年12月，对10例肝移植术后复发性丙型肝炎病毒感染（4例）、排斥反应（5例）和门静脉血栓形成（1例）患者行TIPS。11例TIPS（1例患者接受了2次TIPS手术）用于治疗难治性腹水（n = 7）、胸腔积液（n = 2）或结肠静脉曲张出血（n = 1）。LT和TIPS放置之间的中位时间间隔为15（4-158）mo。平均门体压力梯度从12.5 mmHg降至8.7 mmHg。43%和29%的腹水患者可获得完全和部分缓解。两例胸腔积液患者对TIPS均无反应。结肠静脉曲张患者无再出血。10例患者中有9例在研究期间死亡。在TIPS手术后接受再次移植的两名患者中只有一名存活。TIPS置入后的中位生存期为3.3（范围0.4-20）个月。大多数患者死于脓毒症伴多器官功能衰竭。结论：肝移植患者TIPS的适应证和技术性能与非移植患者一致。在大多数患者中，至少可以部分控制难治性腹水和静脉曲张出血。然而，生存率令人失望，最可能的原因是TIPS放置时肝脏疾病的晚期和免疫抑制导致的脓毒症的高风险。(C)2009 WJG出版社和百世登。All rights reserved.
AIM: To evaluate the efficacy of transjugular intrahepatic portosystemic shunts (TIPSs) after liver transplantation (LT).METHODS: Between November 1996 and December 2005, 10 patients with severe recurrent hepatitis C virus infection (n = 4), ductopenic rejection (n = 5) or portal vein thrombosis (n = 1) were included in this analysis. Eleven TIPSs (one patient underwent two TIPS procedures) were placed for management of therapy-refractory ascites (n = 7), hydrothorax (n = 2) or bleeding from colonic varices (n = 1). The median time interval between LT and TIPS placement was 15 (4-158) mo.RESULTS: TIPS placement was successful in all patients. The mean portosystemic pressure gradient was reduced from 12.5 to 8.7 mmHg. Complete and partial remission could be achieved in 43% and 29% of patients with ascites. Both patients with hydrothorax did not respond to TIPS. No recurrent bleeding was seen in the patient with colonic varices. Nine of 10 patients died during the study period. Only one of two patients, who underwent retransplantation after the TIPS procedure, survived. The median survival period after TIPS placement was 3.3 (range 0.4-20) mo. The majority of patients died from sepsis with multiorgan failure.CONCLUSION: Indications for TIPS and technical performance in LT patients correspond to those in non-transplanted patients. At least partial control of therapy-refractory ascites and variceal bleeding could be achieved in most patients. Nevertheless, survival rates were disappointing, most probably because of the advanced stages of liver disease at the time of TIPS placement and the high risk of sepsis as a consequence of immunosuppression. (C) 2009 The WJG Press and Baishideng. All rights reserved.