Clinical outcomes of transjugular intrahepatic portosystemic shunt with PTFE-covered stents after liver transplantation and technical results in split and whole liver graft recipients
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 Sing...
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| Veröffentlicht in: | European radiology 2023-04, Vol.33 (4), p.2612-2619 |
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| creator | Maruzzelli, Luigi D’Amico, Mario Tuzzolino, Fabio Petridis, Ioannis Gruttadauria, Salvatore Miraglia, Roberto Luca, Angelo |
| description | 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. |
| doi_str_mv | 10.1007/s00330-022-09259-4 |
| format | Article |
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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.</description><identifier>ISSN: 1432-1084</identifier><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-022-09259-4</identifier><identifier>PMID: 36418620</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Ascites ; Ascites - complications ; Complications ; Diagnostic Radiology ; Esophageal and Gastric Varices - etiology ; Feasibility ; Gastrointestinal Hemorrhage - etiology ; Grafting ; Hepatic encephalopathy ; Humans ; Hypertension ; Hypertension, Portal - complications ; Imaging ; Implants ; Internal Medicine ; Interventional ; Interventional Radiology ; Liver ; Liver transplantation ; Liver Transplantation - adverse effects ; Liver transplants ; Medicine ; Medicine & Public Health ; Neuroradiology ; Patients ; Polytetrafluoroethylene ; Portasystemic Shunt, Transjugular Intrahepatic - methods ; Radiology ; Retrospective Studies ; Stents ; Stents - adverse effects ; Transplantation ; Transplants & implants ; Treatment Outcome ; Ultrasound</subject><ispartof>European radiology, 2023-04, Vol.33 (4), p.2612-2619</ispartof><rights>The Author(s), under exclusive licence to European Society of Radiology 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to European Society of Radiology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-32ca6b713b7d3c1d0a5b58ad56ee3995e13e414563e3b03b46087471d770f3a93</citedby><cites>FETCH-LOGICAL-c375t-32ca6b713b7d3c1d0a5b58ad56ee3995e13e414563e3b03b46087471d770f3a93</cites><orcidid>0000-0002-4807-9219</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-022-09259-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-022-09259-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36418620$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maruzzelli, Luigi</creatorcontrib><creatorcontrib>D’Amico, Mario</creatorcontrib><creatorcontrib>Tuzzolino, Fabio</creatorcontrib><creatorcontrib>Petridis, Ioannis</creatorcontrib><creatorcontrib>Gruttadauria, Salvatore</creatorcontrib><creatorcontrib>Miraglia, Roberto</creatorcontrib><creatorcontrib>Luca, Angelo</creatorcontrib><title>Clinical outcomes of transjugular intrahepatic portosystemic shunt with PTFE-covered stents after liver transplantation and technical results in split and whole liver graft recipients</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>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.</description><subject>Ascites</subject><subject>Ascites - complications</subject><subject>Complications</subject><subject>Diagnostic Radiology</subject><subject>Esophageal and Gastric Varices - etiology</subject><subject>Feasibility</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Grafting</subject><subject>Hepatic encephalopathy</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension, Portal - complications</subject><subject>Imaging</subject><subject>Implants</subject><subject>Internal Medicine</subject><subject>Interventional</subject><subject>Interventional Radiology</subject><subject>Liver</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - adverse effects</subject><subject>Liver transplants</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neuroradiology</subject><subject>Patients</subject><subject>Polytetrafluoroethylene</subject><subject>Portasystemic Shunt, Transjugular Intrahepatic - methods</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Stents - adverse effects</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><subject>Ultrasound</subject><issn>1432-1084</issn><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kc1u1TAQhSNERUvLC7BAltiwCR1nnDhZoqsWkCrBol1HjjO58VViB9uh6pPxerjN5UcsWNkz850ztk6WvebwngPIywCACDkURQ5NUTa5eJadcYFFzqEWz_-6n2YvQzgAQMOFfJGdYiV4XRVwlv3YTcYarSbm1qjdTIG5gUWvbDis-3VSnhmbypEWFY1mi_PRhYcQaU5VGFcb2b2JI_t6e32Va_edPPUsjW0MTA2RPJtMam6Wy6RsTD7OMmV7FkmP23JPYZ2SwliWIBOfxvejm-go3_tkljBtFvPofZGdDGoK9Op4nmd311e3u0_5zZePn3cfbnKNsow5FlpVneTYyR4170GVXVmrvqyIsGlK4kiCi7JCwg6wExXUUkjeSwkDqgbPs3eb7-Ldt5VCbGcTNE3pI-TW0BYSGymwrjGhb_9BD271Nr0uUbUEUcoSElVslPYuBE9Du3gzK__QcmgfY223WNsUa_sUayuS6M3Reu1m6n9LfuWYANyAkEZ2T_7P7v_Y_gQKKrHl</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Maruzzelli, Luigi</creator><creator>D’Amico, Mario</creator><creator>Tuzzolino, Fabio</creator><creator>Petridis, Ioannis</creator><creator>Gruttadauria, Salvatore</creator><creator>Miraglia, Roberto</creator><creator>Luca, Angelo</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4807-9219</orcidid></search><sort><creationdate>20230401</creationdate><title>Clinical outcomes of transjugular intrahepatic portosystemic shunt with PTFE-covered stents after liver transplantation and technical results in split and whole liver graft recipients</title><author>Maruzzelli, Luigi ; D’Amico, Mario ; Tuzzolino, Fabio ; Petridis, Ioannis ; Gruttadauria, Salvatore ; Miraglia, Roberto ; Luca, Angelo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-32ca6b713b7d3c1d0a5b58ad56ee3995e13e414563e3b03b46087471d770f3a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Ascites</topic><topic>Ascites - complications</topic><topic>Complications</topic><topic>Diagnostic Radiology</topic><topic>Esophageal and Gastric Varices - etiology</topic><topic>Feasibility</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Grafting</topic><topic>Hepatic encephalopathy</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension, Portal - complications</topic><topic>Imaging</topic><topic>Implants</topic><topic>Internal Medicine</topic><topic>Interventional</topic><topic>Interventional Radiology</topic><topic>Liver</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - adverse effects</topic><topic>Liver transplants</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neuroradiology</topic><topic>Patients</topic><topic>Polytetrafluoroethylene</topic><topic>Portasystemic Shunt, Transjugular Intrahepatic - methods</topic><topic>Radiology</topic><topic>Retrospective Studies</topic><topic>Stents</topic><topic>Stents - adverse effects</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maruzzelli, Luigi</creatorcontrib><creatorcontrib>D’Amico, Mario</creatorcontrib><creatorcontrib>Tuzzolino, Fabio</creatorcontrib><creatorcontrib>Petridis, Ioannis</creatorcontrib><creatorcontrib>Gruttadauria, Salvatore</creatorcontrib><creatorcontrib>Miraglia, Roberto</creatorcontrib><creatorcontrib>Luca, Angelo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maruzzelli, Luigi</au><au>D’Amico, Mario</au><au>Tuzzolino, Fabio</au><au>Petridis, Ioannis</au><au>Gruttadauria, Salvatore</au><au>Miraglia, Roberto</au><au>Luca, Angelo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcomes of transjugular intrahepatic portosystemic shunt with PTFE-covered stents after liver transplantation and technical results in split and whole liver graft recipients</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>33</volume><issue>4</issue><spage>2612</spage><epage>2619</epage><pages>2612-2619</pages><issn>1432-1084</issn><issn>0938-7994</issn><eissn>1432-1084</eissn><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>36418620</pmid><doi>10.1007/s00330-022-09259-4</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-4807-9219</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | European radiology, 2023-04, Vol.33 (4), p.2612-2619 |
| issn | 1432-1084 0938-7994 1432-1084 |
| language | eng |
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| source | MEDLINE; SpringerNature Complete Journals |
| subjects | Ascites Ascites - complications Complications Diagnostic Radiology Esophageal and Gastric Varices - etiology Feasibility Gastrointestinal Hemorrhage - etiology Grafting Hepatic encephalopathy Humans Hypertension Hypertension, Portal - complications Imaging Implants Internal Medicine Interventional Interventional Radiology Liver Liver transplantation Liver Transplantation - adverse effects Liver transplants Medicine Medicine & Public Health Neuroradiology Patients Polytetrafluoroethylene Portasystemic Shunt, Transjugular Intrahepatic - methods Radiology Retrospective Studies Stents Stents - adverse effects Transplantation Transplants & implants Treatment Outcome Ultrasound |
| title | Clinical outcomes of transjugular intrahepatic portosystemic shunt with PTFE-covered stents after liver transplantation and technical results in split and whole liver graft recipients |
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