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Clinical outcomes of transjugular intrahepatic portosystemic shunt with PTFE-covered stents after liver transplantation and technical results in split and whole liver graft recipients

  • Interventional
  • Published:
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Abstract

Objectives

To assess the outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation using PTFE-covered stents in liver transplant (LT) recipients and to analyze the technical result of TIPS creation in split grafts (SG) compared with whole liver grafts (WG).

Methods and materials

Single-center, retrospective study, analyzing LT patients who underwent TIPS using PTFE-covered stents. Clinical and technical variables were analyzed.

Results

Between 2005 and 2021, TIPS was created using PTFE-covered stents in 48 LT patients at a median of 43 months (range, 0.5–192) after LT. TIPS indications were refractory ascites (RA) in 33 patients (69%), variceal bleeding (VB) in 9 patients (19%), others in 6 (12%). Ten patients (21%) received a SG. Technical success rate was 100% in both groups: in two WG recipients, (5%) a second attempt was required. An unconventional approach (combined transhepatic or transplenic access) was needed in 2 WG (5%) and 2 SG recipients (20%). Two procedure-related death occurred in the WG group. After a median follow-up of 22 months (range, 0,1–144), 16 patients (48%) in the RA group did not require post-TIPS paracentesis, in the VB group rebleeding occurred in 3 patients (33%). Fifteen patients (31%) underwent TIPS revision. Overt hepatic encephalopathy occurred in 14 patients (29%). Patient survival at 6 months, 1 year, and 3 years was 77%, 66%, and 43%, respectively.

Conclusions

The feasibility and safety of TIPS creation in SG are comparable to that of WG. TIPS creation using PTFE-covered stents represents a viable option to treat portal hypertensive complications in LT recipients.

Key Points

• TIPS creation using PTFE-covered stents represents a viable option to treat complications of PH in LT recipients.

• TIPS creation in LT SG recipients appears to be safe and feasible as in WG.

• Results from this study may help to refine the management of LT patients with recurrent portal hypertensive complications encouraging physicians to consider TIPS creation as a treatment option in both SG and WG recipients.

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Abbreviations

CI:

Confidence interval

CP:

Child-Pugh

HE:

Hepatic encephalopathy

HR:

Hazard ratio

HV:

Hepatic vein

IVC:

Inferior vena cava

LT:

Liver transplant

MELD:

Model for end-stage liver disease

PH:

Portal hypertension

PSG:

Portosystemic pressure gradient

PTFE:

Polytetrafluoroethylene

PV:

Portal vein

PVT:

Portal vein thrombosis

RA:

Refractory ascites

SG:

Split graft

TIPS:

Transjugular intrahepatic portosystemic shunt

US:

Ultrasound

VB:

Variceal bleeding

WG:

Whole graft

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), University of Pittsburgh Medical Center Italy (UPMC Italy), via Tricomi 5, 90127, Palermo, Italy

    Luigi Maruzzelli, Roberto Miraglia & Angelo Luca

  2. Interventional Radiology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Viale Strasburgo 233, 90146, Palermo, Italy

    Mario D’Amico

  3. Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center Italy (UPMC Italy), via Tricomi 5, 90127, Palermo, Italy

    Fabio Tuzzolino, Ioannis Petridis & Salvatore Gruttadauria

Authors
  1. Luigi Maruzzelli
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  2. Mario D’Amico
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  3. Fabio Tuzzolino
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  4. Ioannis Petridis
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  5. Salvatore Gruttadauria
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  6. Roberto Miraglia
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  7. Angelo Luca
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Corresponding author

Correspondence to Luigi Maruzzelli.

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Guarantor

The scientific guarantor of this publication is Luigi Maruzzelli.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Fabio Tuzzolino kindly provided statistical advice for this manuscript.

Informed consent

Our retrospective cohort study was reviewed and approved by the institutional research review board, and informed consent form was waived. Informed written consent to the TIPS procedure was obtained from all patients.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Maruzzelli, L., D’Amico, M., Tuzzolino, F. et al. Clinical outcomes of transjugular intrahepatic portosystemic shunt with PTFE-covered stents after liver transplantation and technical results in split and whole liver graft recipients. Eur Radiol 33, 2612–2619 (2023). https://doi.org/10.1007/s00330-022-09259-4

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