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Published on: May 7, 2015
Transjugular portosystemic shunts in pediatric patients awaiting liver transplantation
S P Johnson1, J R Leyendecker, F B Joseph
1Department of Radiology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas 78236-5300, USA.
Insights
Transjugular intrahepatic portosystemic shunt (TIPS) placement is a feasible and effective treatment for controlling variceal bleeding in pediatric patients awaiting liver transplantation, without complicating future surgeries.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Hepatology
Background:
- End-stage liver disease in children often leads to variceal bleeding.
- Endoscopic sclerotherapy may fail to control active variceal hemorrhage.
- Liver transplantation is a definitive treatment, but bleeding requires immediate management.
Observation:
- Three pediatric patients (6-11 years) with end-stage liver disease underwent transjugular intrahepatic portosystemic shunt (TIPS) placement for variceal bleeding.
- Procedures were emergent in two patients after failed sclerotherapy and elective in one.
- Shunts were created between hepatic veins and the portal vein.
Findings:
- Transjugular intrahepatic portosystemic shunt (TIPS) placement successfully controlled variceal bleeding in all three pediatric patients.
- No major or minor complications were associated with TIPS placement.
- Subsequent liver transplant surgeries were not complicated by the presence of the TIPS stents.
Implications:
- Transjugular intrahepatic portosystemic shunt (TIPS) is a technically feasible option for pediatric variceal hemorrhage.
- TIPS placement can effectively manage acute bleeding in children awaiting liver transplantation.
- This procedure does not impede or complicate subsequent liver transplant surgery.
Abstract:
Three pediatric patients from 6 to 11 years of age awaiting liver transplantation for end stage liver disease underwent transjugular intrahepatic portosystemic shunt (TIPS) placement for control of variceal bleeding. Two of the three procedures were performed emergently after endoscopic sclerotherapy failed to stop active bleeding. One procedure was performed electively after multiple prior bleeding episodes. The shunts were created from the middle or left hepatic vein to the left portal vein, and none of the subsequent transplant surgeries was complicated by the presence of the stents. No major or minor complications were related to TIPS placement. Two patients underwent concomitant variceal embolization. Bleeding was successfully controlled in each patient. We conclude that TIPS placement in children is technically feasible, does not complicate subsequent surgery, and is useful treating acute variceal hemorrhage in pediatric patients awaiting liver transplantation.
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