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Yoeli D, Galván NTN, Ashton DJ, Kumm KR, Kueht ML, Witte ED, Miloh TA, Cotton RT, Rana A, O'Mahony CA, Goss JA. Portosystemic shunt as a bridge to liver transplantation in infants: A comparison of two techniques. Pediatr Transplant 2017; 21. [PMID: 28295949 DOI: 10.1111/petr.12915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
Portosystemic shunts can serve as a bridge to liver transplantation in patients with end-stage liver disease by providing portal decompression to treat life-threatening variceal bleeding and prevent recurrent episodes until an organ becomes available. The conventional TIPS procedure, however, is technically challenging to perform in infants due to the small size of their intrahepatic vasculature. We report two cases of emergent creation of portosystemic shunts as a bridge to liver transplantation in infants with life-threatening variceal bleeding using a conventional TIPS technique in the first case and a percutaneous DIPS technique in the other. Both procedures were successful at reducing the portosystemic pressure gradient and preventing further variceal bleeds until a liver transplant could be performed. The novel percutaneous DIPS procedure is a valuable alternative to the conventional TIPS in infants, as it is better suited for small or challenging intrahepatic vascular anatomy.
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Affiliation(s)
- Dor Yoeli
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - N Thao N Galván
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Daniel J Ashton
- Department of Radiology, Division of Pediatric Radiology, Baylor College of Medicine, Houston, TX, USA.,Department of Radiology, Division of Interventional Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Kayla R Kumm
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Michael L Kueht
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Ellen D Witte
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Tamir A Miloh
- Department of Pediatrics, Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA.,Department of Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX, USA
| | - Ronald T Cotton
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Abbas Rana
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Christine A O'Mahony
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - John A Goss
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
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Emre S, Dugan C, Frankenberg T, Hudgins LC, Gagliardi R, Artis AT, Rodriguez-Laiz G, Gondolesi G, Shneider BL, Kerkar N. Surgical portosystemic shunts and the Rex bypass in children: a single-centre experience. HPB (Oxford) 2009; 11:252-7. [PMID: 19590656 PMCID: PMC2697896 DOI: 10.1111/j.1477-2574.2009.00047.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 02/15/2009] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to illustrate the indications for, and types and outcomes of surgical portosystemic shunt (PSS) and/or Rex bypass in a single centre. METHODS Data were collected from children with a PSS and/or Rex bypass between 1992 and 2006 at Mount Sinai Medical Center, New York. RESULTS Median age at surgery was 10.7 years (range 0.3-22.0 years). Indications included: (i) refractory gastrointestinal bleeding in portal hypertension associated with (a) compensated cirrhosis (n= 12), (b) portal vein thrombosis (n= 10), (c) hepatoportal sclerosis (n= 3); (ii) refractory ascites secondary to Budd-Chiari syndrome (n= 3), and (iii) familial hypercholesterolaemia (n= 4). There were 20 distal splenorenal, four portacaval, three Rex bypass, two mesocaval, two mesoatrial and one proximal splenorenal shunts. At the last follow-up (median 2.9 years, range 0.1-14.1 years), one shunt (Rex bypass) was thrombosed. Two patients had died and two had required a liver transplant. These had a patent shunt at last imaging prior to death or transplant. CONCLUSIONS Portosystemic shunts and Rex bypass have been used to manage portal hypertension with excellent outcomes. In selected children with compensated liver disease, PSS may act as a bridge to liver transplantation or represent an attractive alternative.
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Affiliation(s)
- Sukru Emre
- Recanati Miller Transplant Institute, Mount Sinai School of MedicineNew York, NY, USA,Department of Surgery, Yale University School of MedicineNew Haven, CT, USA
| | - Christina Dugan
- Recanati Miller Transplant Institute, Mount Sinai School of MedicineNew York, NY, USA
| | - Tamara Frankenberg
- Recanati Miller Transplant Institute, Mount Sinai School of MedicineNew York, NY, USA
| | | | - Rosemarie Gagliardi
- Recanati Miller Transplant Institute, Mount Sinai School of MedicineNew York, NY, USA
| | - A Tarik Artis
- Recanati Miller Transplant Institute, Mount Sinai School of MedicineNew York, NY, USA
| | | | - Gabriel Gondolesi
- Recanati Miller Transplant Institute, Mount Sinai School of MedicineNew York, NY, USA,Fundación Favaloro, Buenos AiresArgentina
| | - Benjamin L Shneider
- Recanati Miller Transplant Institute, Mount Sinai School of MedicineNew York, NY, USA,Department of Paediatrics, Mount Sinai School of MedicineNew York, NY, USA,Department of Paediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical CenterPittsburgh, PA, USA
| | - Nanda Kerkar
- Recanati Miller Transplant Institute, Mount Sinai School of MedicineNew York, NY, USA,Department of Paediatrics, Mount Sinai School of MedicineNew York, NY, USA
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Mermuys K, Maleux G, Heye S, Lombaerts R, Nevens F. Use of the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt creation in children: initial clinical experience. Cardiovasc Intervent Radiol 2008; 31 Suppl 2:S192-6. [PMID: 18183459 DOI: 10.1007/s00270-007-9262-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 10/26/2007] [Accepted: 11/28/2007] [Indexed: 01/15/2023]
Abstract
Four children, three boys and one girl, with a median age of 9 years 8 months, underwent transjugular intrahepatic portosystemic shunt creation with an expanded polytetrafluoroethylene (e-PTFE)-covered nitinol stent. The stent-graft was successfully placed in all four patients without any complication. Clinical and biochemical improvement was noted in all four patients during follow-up. Radiological follow-up with use of duplex ultrasound showed a recurrent stenosis of the shunt 180 days after stent-graft implantation in one patient. This was treated with placement of an additional stent-graft, re-expanding completely the recurrent stenosis. In the other three patients, the stent-graft remained fully patent until the end of the study or until orthotopic liver transplantation. These preliminary results suggest that use of the Viatorr ePTFE-covered stent-graft in children is safe and feasible, with potentially the same high patency rate and improved clinical outcome as reported in adult patients.
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Affiliation(s)
- Koen Mermuys
- Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
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