Abstract
A transjugular intrahepatic portal-systemic shunt (TIPS) is a standard way to decompress the portal system in cirrhotic patients as a bridge to orthotopic liver transplantation (OLT). Traditionally, TIPS has been indicated for certain portal hypertensive sequelae such as refractory ascites, varices treatment and even hepato-hydrothorax. Herein is a case report on the efficacy of TIPS in an OLT ineligible patient with primary biliary cirrhosis and aplastic anemia who had developed refractive ascites requiring serial paracentesis and esophageal varices. He survived 2.5 years post-TIPS placement and died from complications related to severe leucopenia and the development of sepsis.
Highlights
A transjugular intrahepatic portal-systemic shunt (TIPS) is a standard way to decompress the portal system in cirrhotic patients as a bridge to orthotopic liver transplantation (OLT)
The Transjugular intrahepatic portal-systemic shunt (TIPS) is a standard interventional radiological technique that is utilized in cirrhotic patients to treat major complications of portal hypertension such as refractory ascites and hepato-hydrothorax, secondary prevention of esophageal varices, and primary prevention of gastric varices [1,2,3,4]
Cirrhosis is manifested by an extensive fibronodular replacement of the liver parenchyma with resultant portal hypertension and progressive synthetic dysfunction [4]
Summary
The Transjugular intrahepatic portal-systemic shunt (TIPS) is a standard interventional radiological technique that is utilized in cirrhotic patients to treat major complications of portal hypertension such as refractory ascites and hepato-hydrothorax, secondary prevention of esophageal varices, and primary prevention of gastric varices [1,2,3,4]. OLT is a complex standard-of-care surgery for eligible chronic decompensated liver disease and fulminant liver failure patients [4]. The success of this technology has rested upon improvements in immunosuppressive therapies, surgical technique and appropriate patient selection. Given the technical challenges of TIPS, and the expected physiologic changes induced, eligible patients must fulfill a number of criteria including absence of sepsis, absence of severe cardiopulmonary disease, and few prior episodes of hepatic encephalopathy (HE). Is a report of a case for the successful utilization of a TIPS procedure in a patient with decompensated primary biliary cirrhosis (PBC), deemed ineligible for OLT given the high morbidity and mortality of his aplastic anemia
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