Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation
Severe veno-occlusive disease (VOD) of the liver is a leading cause of mortality after bone marrow transplantation (BMT). Vascular and parenchymal injuries account for acute portal hypertension and liver failure is frequently present. We describe the results of transjugular intrahepatic portosystemi...
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| Veröffentlicht in: | Bone marrow transplantation (Basingstoke) 2000-05, Vol.25 (9), p.987-992 |
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| creator | AZOULAY, D CASTAING, D LEMOINE, A HARGREAVES, G. M BISMUTH, H |
| description | Severe veno-occlusive disease (VOD) of the liver is a leading cause of mortality after bone marrow transplantation (BMT). Vascular and parenchymal injuries account for acute portal hypertension and liver failure is frequently present. We describe the results of transjugular intrahepatic portosystemic shunt (TIPS) for the management of VOD after BMT. TIPS was performed in 10 patients with histologically proven severe VOD. Portal hypertension was controlled by TIPS in all patients (mean hepatic venous pressure gradient before, 20 +/- 11 vs 6 +/- 5 mm Hg after TIPS, P < 0.01) without technical complications. Five patients with rapidly worsening VOD died within 10 days of TIPS without any improvement. The five remaining patients with less advanced disease showed improvement in various clinical and biological parameters. Four patients subsequently died. The lone survivor continues to do well with resolution of VOD 6 months after TIPS. TIPS can be performed safely and controls portal hypertension in VOD after BMT. Arguments from the present series and from eight previously reported cases favour earlier application of TIPS to obtain improved overall survival. Bone Marrow Transplantation (2000) 25, 987-992. |
| doi_str_mv | 10.1038/sj.bmt.1702386 |
| format | Article |
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M ; BISMUTH, H</creator><creatorcontrib>AZOULAY, D ; CASTAING, D ; LEMOINE, A ; HARGREAVES, G. M ; BISMUTH, H</creatorcontrib><description>Severe veno-occlusive disease (VOD) of the liver is a leading cause of mortality after bone marrow transplantation (BMT). Vascular and parenchymal injuries account for acute portal hypertension and liver failure is frequently present. We describe the results of transjugular intrahepatic portosystemic shunt (TIPS) for the management of VOD after BMT. TIPS was performed in 10 patients with histologically proven severe VOD. Portal hypertension was controlled by TIPS in all patients (mean hepatic venous pressure gradient before, 20 +/- 11 vs 6 +/- 5 mm Hg after TIPS, P < 0.01) without technical complications. Five patients with rapidly worsening VOD died within 10 days of TIPS without any improvement. The five remaining patients with less advanced disease showed improvement in various clinical and biological parameters. Four patients subsequently died. The lone survivor continues to do well with resolution of VOD 6 months after TIPS. TIPS can be performed safely and controls portal hypertension in VOD after BMT. Arguments from the present series and from eight previously reported cases favour earlier application of TIPS to obtain improved overall survival. Bone Marrow Transplantation (2000) 25, 987-992.</description><identifier>ISSN: 0268-3369</identifier><identifier>EISSN: 1476-5365</identifier><identifier>DOI: 10.1038/sj.bmt.1702386</identifier><identifier>PMID: 10800068</identifier><identifier>CODEN: BMTRE9</identifier><language>eng</language><publisher>Basingstoke: Nature Publishing Group</publisher><subject>Adolescent ; Adult ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Bone marrow ; Bone marrow transplantation ; Bone Marrow Transplantation - adverse effects ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Child ; Complications ; Female ; Hepatic Veno-Occlusive Disease - etiology ; Hepatic Veno-Occlusive Disease - surgery ; Humans ; Hypertension ; Liver ; Liver diseases ; Male ; Medical sciences ; Middle Aged ; Patients ; Portasystemic Shunt, Transjugular Intrahepatic ; Stem cell transplantation ; Tips ; Transfusions. Complications. Transfusion reactions. 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M</creatorcontrib><creatorcontrib>BISMUTH, H</creatorcontrib><title>Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation</title><title>Bone marrow transplantation (Basingstoke)</title><addtitle>Bone Marrow Transplant</addtitle><description>Severe veno-occlusive disease (VOD) of the liver is a leading cause of mortality after bone marrow transplantation (BMT). Vascular and parenchymal injuries account for acute portal hypertension and liver failure is frequently present. We describe the results of transjugular intrahepatic portosystemic shunt (TIPS) for the management of VOD after BMT. TIPS was performed in 10 patients with histologically proven severe VOD. Portal hypertension was controlled by TIPS in all patients (mean hepatic venous pressure gradient before, 20 +/- 11 vs 6 +/- 5 mm Hg after TIPS, P < 0.01) without technical complications. Five patients with rapidly worsening VOD died within 10 days of TIPS without any improvement. The five remaining patients with less advanced disease showed improvement in various clinical and biological parameters. Four patients subsequently died. The lone survivor continues to do well with resolution of VOD 6 months after TIPS. TIPS can be performed safely and controls portal hypertension in VOD after BMT. Arguments from the present series and from eight previously reported cases favour earlier application of TIPS to obtain improved overall survival. Bone Marrow Transplantation (2000) 25, 987-992.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Bone marrow</subject><subject>Bone marrow transplantation</subject><subject>Bone Marrow Transplantation - adverse effects</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Child</subject><subject>Complications</subject><subject>Female</subject><subject>Hepatic Veno-Occlusive Disease - etiology</subject><subject>Hepatic Veno-Occlusive Disease - surgery</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Liver</subject><subject>Liver diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Portasystemic Shunt, Transjugular Intrahepatic</subject><subject>Stem cell transplantation</subject><subject>Tips</subject><subject>Transfusions. Complications. Transfusion reactions. 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Graft versus host reaction</topic><topic>Child</topic><topic>Complications</topic><topic>Female</topic><topic>Hepatic Veno-Occlusive Disease - etiology</topic><topic>Hepatic Veno-Occlusive Disease - surgery</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Liver</topic><topic>Liver diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Portasystemic Shunt, Transjugular Intrahepatic</topic><topic>Stem cell transplantation</topic><topic>Tips</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><topic>Transplantation</topic><topic>Veno-occlusive disease</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>AZOULAY, D</creatorcontrib><creatorcontrib>CASTAING, D</creatorcontrib><creatorcontrib>LEMOINE, A</creatorcontrib><creatorcontrib>HARGREAVES, G. 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M</au><au>BISMUTH, H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation</atitle><jtitle>Bone marrow transplantation (Basingstoke)</jtitle><addtitle>Bone Marrow Transplant</addtitle><date>2000-05-01</date><risdate>2000</risdate><volume>25</volume><issue>9</issue><spage>987</spage><epage>992</epage><pages>987-992</pages><issn>0268-3369</issn><eissn>1476-5365</eissn><coden>BMTRE9</coden><abstract>Severe veno-occlusive disease (VOD) of the liver is a leading cause of mortality after bone marrow transplantation (BMT). Vascular and parenchymal injuries account for acute portal hypertension and liver failure is frequently present. We describe the results of transjugular intrahepatic portosystemic shunt (TIPS) for the management of VOD after BMT. TIPS was performed in 10 patients with histologically proven severe VOD. Portal hypertension was controlled by TIPS in all patients (mean hepatic venous pressure gradient before, 20 +/- 11 vs 6 +/- 5 mm Hg after TIPS, P < 0.01) without technical complications. Five patients with rapidly worsening VOD died within 10 days of TIPS without any improvement. The five remaining patients with less advanced disease showed improvement in various clinical and biological parameters. Four patients subsequently died. The lone survivor continues to do well with resolution of VOD 6 months after TIPS. TIPS can be performed safely and controls portal hypertension in VOD after BMT. Arguments from the present series and from eight previously reported cases favour earlier application of TIPS to obtain improved overall survival. Bone Marrow Transplantation (2000) 25, 987-992.</abstract><cop>Basingstoke</cop><pub>Nature Publishing Group</pub><pmid>10800068</pmid><doi>10.1038/sj.bmt.1702386</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Bone marrow Bone marrow transplantation Bone Marrow Transplantation - adverse effects Bone marrow, stem cells transplantation. Graft versus host reaction Child Complications Female Hepatic Veno-Occlusive Disease - etiology Hepatic Veno-Occlusive Disease - surgery Humans Hypertension Liver Liver diseases Male Medical sciences Middle Aged Patients Portasystemic Shunt, Transjugular Intrahepatic Stem cell transplantation Tips Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Veno-occlusive disease |
| title | Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation |
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