Evaluation of transjugular intrahepatic portosystemic shunt (TIPS) as a previous step to liver transplantation in pediatric patients.

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) was designed to treat complications of portal hypertension (PH). The objective of this study was to analyze the results of the TIPS performed in pediatric patients in our institution as a previous step to liver transplantation (LT). A retrospective, descriptive study of pediatric patients with liver cirrhosis undergoing TIPS prior to LT from 2015 to 2020 was carried out. TIPS was performed in 10 patients. The reason for TIPS was hard-to-control ascites in 7 patients (70%), upper gastrointestinal bleeding due to esophageal varices in 1 patient (10%), and portal hypoplasia in 2 cases (20%). No intraoperative complications were recorded. Stent patency was achieved in all cases. TIPS patency until LT was observed in 6 patients (60%). Indirect signs of patency were noted in 1 patient (10%). 2 patients (20%) required re-intervention, with patency being achieved in the second attempt. And finally, no patency was observed after 3 attempts in 1 patient (10%). A decrease in portocaval gradient (p = 0.001) and an increase in portal velocity (p = 0.006) were observed. No platelet count changes were found. A slight, non-significant increase in ammonia was noted. TIPS is a safe and effective procedure to reduce complications of hard-to-control PH in pediatric patients. It allows general condition to be optimized, deterioration to be avoided, and portal vein narrowing to be alleviated in cirrhosis patients as a previous step to LT.