4:33 PM Abstract No. 213 - Portal vein recanalization-transjugular intrahepatic portosystemic shunt using the trans-splenic approach to achieve transplant candidacy in patients with chronic portal vein thrombosis: proof of concept

Abstract

PurposeThe aim of this study is to test our hypothesis that the trans-splenic (TS) route can be employed as an alternate approach for portal vein recanalization-transjugular portosystemic shunts (PVR-TIPS) for chronic main portal vein thrombosis (mPVT) in potential transplant candidates.Materials and MethodsWith IRB approval, 11 consecutive patients with cirrhosis-induced chronic mPVT underwent trans-splenic PVR-TIPS in 2013-2014. All patients were denied listing by our transplant team due to the presence of mPVT, a relative contraindication at our center. Patients were followed for adverse events. PV patency at follow-up was assessed by 1-month splenoportography and subsequently by ultrasound/MRI every 3 months. Following PVR-TIPS, patients were reviewed (and subsequently listed) at weekly multidisciplinary conference.ResultsPVR-TIPS using the TS approach was successful in all 11 patients with no major complications. Median age was 61 years (range: 33-67), 9/11 (82%) were male, and non-alcoholic steatohepatitis / hepatitis C were the leading causes of liver disease (8/11, 4 each). Complete mPVT was found in 8/11 (73%) patients. Four out of 11 patients (36%) had a MELD >18 and 8/11 (73%) had a baseline Child-Pugh score 7-10. Minor adverse events occurred in 2/11 (fever, encephalopathy). Five out of eleven patients (45%) exhibited some minor remaining thrombus in the PV at the end of the procedure; of these patients, 3/5 had complete thrombus resolution at one month, with the remaining 2/5 resolving at 3 months (no anticoagulation). Three patients underwent successful transplantation with end-to-end anastomoses.ConclusionTrans-splenic PVR-TIPS is a potentially safe and effective method to treat PVT and improve transplant candidacy. PurposeThe aim of this study is to test our hypothesis that the trans-splenic (TS) route can be employed as an alternate approach for portal vein recanalization-transjugular portosystemic shunts (PVR-TIPS) for chronic main portal vein thrombosis (mPVT) in potential transplant candidates. The aim of this study is to test our hypothesis that the trans-splenic (TS) route can be employed as an alternate approach for portal vein recanalization-transjugular portosystemic shunts (PVR-TIPS) for chronic main portal vein thrombosis (mPVT) in potential transplant candidates. Materials and MethodsWith IRB approval, 11 consecutive patients with cirrhosis-induced chronic mPVT underwent trans-splenic PVR-TIPS in 2013-2014. All patients were denied listing by our transplant team due to the presence of mPVT, a relative contraindication at our center. Patients were followed for adverse events. PV patency at follow-up was assessed by 1-month splenoportography and subsequently by ultrasound/MRI every 3 months. Following PVR-TIPS, patients were reviewed (and subsequently listed) at weekly multidisciplinary conference. With IRB approval, 11 consecutive patients with cirrhosis-induced chronic mPVT underwent trans-splenic PVR-TIPS in 2013-2014. All patients were denied listing by our transplant team due to the presence of mPVT, a relative contraindication at our center. Patients were followed for adverse events. PV patency at follow-up was assessed by 1-month splenoportography and subsequently by ultrasound/MRI every 3 months. Following PVR-TIPS, patients were reviewed (and subsequently listed) at weekly multidisciplinary conference. ResultsPVR-TIPS using the TS approach was successful in all 11 patients with no major complications. Median age was 61 years (range: 33-67), 9/11 (82%) were male, and non-alcoholic steatohepatitis / hepatitis C were the leading causes of liver disease (8/11, 4 each). Complete mPVT was found in 8/11 (73%) patients. Four out of 11 patients (36%) had a MELD >18 and 8/11 (73%) had a baseline Child-Pugh score 7-10. Minor adverse events occurred in 2/11 (fever, encephalopathy). Five out of eleven patients (45%) exhibited some minor remaining thrombus in the PV at the end of the procedure; of these patients, 3/5 had complete thrombus resolution at one month, with the remaining 2/5 resolving at 3 months (no anticoagulation). Three patients underwent successful transplantation with end-to-end anastomoses. PVR-TIPS using the TS approach was successful in all 11 patients with no major complications. Median age was 61 years (range: 33-67), 9/11 (82%) were male, and non-alcoholic steatohepatitis / hepatitis C were the leading causes of liver disease (8/11, 4 each). Complete mPVT was found in 8/11 (73%) patients. Four out of 11 patients (36%) had a MELD >18 and 8/11 (73%) had a baseline Child-Pugh score 7-10. Minor adverse events occurred in 2/11 (fever, encephalopathy). Five out of eleven patients (45%) exhibited some minor remaining thrombus in the PV at the end of the procedure; of these patients, 3/5 had complete thrombus resolution at one month, with the remaining 2/5 resolving at 3 months (no anticoagulation). Three patients underwent successful transplantation with end-to-end anastomoses. ConclusionTrans-splenic PVR-TIPS is a potentially safe and effective method to treat PVT and improve transplant candidacy. Trans-splenic PVR-TIPS is a potentially safe and effective method to treat PVT and improve transplant candidacy.