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Updated: Aug 15, 2025
Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Feasibility and outcomes of transjugular intrahepatic portosystemic shunts in infants
José J Martínez-Rodrigo1, Ali Boukhoubza2, Daniel Pérez Enguix2
1Department of Radiology, Hospital Universitario y Politécnico La Fe, Avda. de Fernando Abril Martorell, 106, 46026, Valencia, Spain. martinez.jjo@gmail.com.
Insights
Transjugular intrahepatic portosystemic shunts (TIPS) are feasible and effective for infants awaiting liver transplants. This procedure safely manages refractory ascites and portal hypertension in this young population.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Hepatology
Background:
- Limited data exists on transjugular intrahepatic portosystemic shunts (TIPS) in infants.
- Pediatric patients, particularly infants, present unique challenges for TIPS procedures.
Purpose of the Study:
- To assess the feasibility, efficacy, and safety of TIPS placement in infants under 12 months.
- To evaluate TIPS as a bridge to liver transplantation in infants with chronic liver disease.
Main Methods:
- Retrospective analysis of 10 infants (<12 months) undergoing TIPS for refractory ascites and portal hypertension.
- Assessment of technical success, hemodynamic changes, ascites resolution, and complications.
- Ultrasound monitoring for complications and ascites; paired-sample t-test for statistical analysis.
Main Results:
- Ten TIPS procedures were technically successful, with one requiring surgical repair.
- Significant improvement in ascites was observed in 90% of infants (3 resolved, 6 reduced).
- Stent thrombosis occurred in 6 infants, managed with angioplasty or covered stents.
Conclusions:
- Transjugular intrahepatic portosystemic shunt (TIPS) placement is a feasible, safe, and effective option for infants awaiting liver transplantation.
- TIPS can successfully manage refractory ascites and portal hypertension in this pediatric population.
Background:
Experience with transjugular intrahepatic portosystemic shunts (TIPS) in the pediatric population, especially in infants, is limited.
Objective:
To evaluate the feasibility, efficacy and safety of TIPS placement in infants.
Materials And Methods:
This retrospective non-comparative observational cohort study analyzed all pediatric patients < 12 months of age treated with TIPS while waiting for liver transplant between October 2018 and April 2021. The sample consisted of 10 infants with chronic liver disease. All had refractory ascites and decreased portal vein size. Their mean age ± standard deviation was 5 ± 1 months and their mean weight was 5.4 ± 1.0 kg. We calculated the pediatric end-stage liver disease score and portosystemic gradients before and after TIPS placement. We used ultrasound to check for complications and to assess the presence of ascites. We used paired-sample t-test for the mean comparison of paired variables.
Results:
Ten TIPS procedures were performed that were technically and hemodynamically successful except for one, in which an extrahepatic portal puncture required surgical repair. Ascites resolved in three infants and was reduced in six. The portal vein size remained stable after TIPS placement. Four infants had early stent thrombosis and two had late stent thrombosis treated with angioplasty or covered stents.
Conclusion:
TIPS placement in infants is a feasible, safe and effective procedure.
