Vasta F, Luca A, Miraglia R, Spada M, Gruttadauria S, Verzaro R, Cintorino D, Mandala L, Arcadipane A, Vizzini G, Gridelli B
Department of Surgery, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT-UPMC Italy, Palermo, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2626-8. doi: 10.1016/j.transproceed.2005.06.007.
Transjugular intrahepatic portosystemic shunt (TIPS) has become an effective treatment for the complications of portal hypertension. We assessed the feasibility and outcome of TIPS in liver transplant recipients who developed delayed graft function (DGF) with portal hypertension.
From June 2003 to June 2004, 80 cadaveric orthotopic liver transplantation (OLTx) have been performed at our institution. Five patients (6.25%) developed DGF with hyperbilirubinemia and ascites with severe portal hypertension and were treated with TIPS placement (in the 6-month time period from the transplantation).
There were no complications related to the procedure. No episodes of encephalopathy were seen. Four patients had better control of the ascites. In one case, we observed complete recovery of the transplanted liver with normalization of the liver function test. Three patients underwent retransplantation (within 7 days from the TIPS), whereas 1 is still on the list 6 months after TIPS placement with recurrent episodes of ascites.
In our preliminary series, TIPS reduced dramatically the portosystemic gradient and improved clinical conditions. The results were negatively affected by the fact that the transplanted liver did not recover its function.
经颈静脉肝内门体分流术（TIPS）已成为治疗门静脉高压并发症的有效方法。我们评估了TIPS在发生移植肝功能延迟恢复（DGF）并伴有门静脉高压的肝移植受者中的可行性及疗效。
2003年6月至2004年6月，我们机构共进行了80例尸体原位肝移植（OLTx）。5例患者（6.25%）发生了伴有高胆红素血症和腹水且门静脉高压严重的DGF，并在移植后的6个月内接受了TIPS置入治疗。
未出现与该手术相关的并发症。未观察到肝性脑病发作。4例患者的腹水得到了更好的控制。1例患者移植肝完全恢复，肝功能检查结果正常。3例患者在TIPS术后7天内接受了再次移植，而1例患者在TIPS置入6个月后仍在等待名单上，腹水反复发作。
在我们的初步系列研究中，TIPS显著降低了门体压力梯度并改善了临床状况。移植肝未能恢复功能对结果产生了负面影响。
