Kim John J, Dasika Narasimham L, Yu Esther, Fontana Robert J
Department of Internal Medicine, 3912 Taubman Center, University of Michigan, Ann Arbor, MI 48109-0362, USA.
Liver Int. 2008 Feb;28(2):240-8. doi: 10.1111/j.1478-3231.2007.01645.x.
The aim of this study was to determine the efficacy and safety of transjugular intrahepatic portosystemic shunts (TIPS) in liver transplant (LT) recipients with refractory ascites/variceal bleeding and to compare the observed outcomes with those obtained in cirrhotic controls.
Clinical features of 14 LT recipients referred for TIPS placement between August 1985 and September 2006 were reviewed and compared with published series and 28 cirrhotic control patients undergoing TIPS.
The median age of the 14 LT recipients was 52 years, 57% had chronic hepatitis C virus and the median time from LT to TIPS placement was 46 months. Portal vein thromboses in two patients and a procedural complication in another patient precluded TIPS deployment. Among the 11 patients who completed TIPS, the mean hepatic venous pressure gradient was significantly reduced post-TIPS (18.3 +/- 6.1 to 9.0 +/- 3.5 mmHg, P<0.01). However, only 50% of the patients with varices had no further bleeding and 57% of the refractory ascites patients required no further paracentesis. In addition to a single peri-procedural death and renal failure in three others, four patients (29%) developed infection and nine (82%) developed new onset or worsening encephalopathy at a median of 11 days post-TIPS. The 1-year patient survival of 14% was substantially lower than that observed in other series of LT recipients (57-67%) as well as the matched cirrhotic control group undergoing TIPS (58%).
The frequent morbidity noted in LT recipients undergoing TIPS, coupled with the low 1-year patient survival, demonstrates that portal decompression provides only marginal short-term benefit in the absence of retransplantation.
本研究旨在确定经颈静脉肝内门体分流术（TIPS）在患有难治性腹水/静脉曲张出血的肝移植（LT）受者中的疗效和安全性，并将观察到的结果与肝硬化对照组的结果进行比较。
回顾了1985年8月至2006年9月期间因TIPS置入而转诊的14例LT受者的临床特征，并与已发表的系列研究以及28例接受TIPS的肝硬化对照患者进行比较。
14例LT受者的中位年龄为52岁，57%患有慢性丙型肝炎病毒，从LT到TIPS置入的中位时间为46个月。两名患者出现门静脉血栓形成，另一名患者出现手术并发症，导致无法进行TIPS置入。在完成TIPS的11例患者中，TIPS术后平均肝静脉压力梯度显著降低（从18.3±6.1降至9.0±3.5 mmHg，P<0.01）。然而，只有50%的静脉曲张患者没有再次出血，57%的难治性腹水患者不需要进一步进行腹腔穿刺术。除了1例围手术期死亡和其他3例肾功能衰竭外，4例患者（29%）发生感染，9例患者（82%）在TIPS术后中位11天出现新发或加重的肝性脑病。14%的1年患者生存率显著低于其他系列LT受者（57-67%）以及接受TIPS的匹配肝硬化对照组（58%）。
接受TIPS的LT受者中常见的发病率，加上较低的1年患者生存率，表明在没有再次移植的情况下，门脉减压仅提供了边际短期益处。
