Cirrhosis surgery: Difference between revisions

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__NOTOC__
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{{Cirrhosis}}
{{Cirrhosis}}
{{CMG}} {{AE}} {{ADI}}
{{CMG}} {{AE}} {{ADI}} {{Cherry}}
 
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==Overview==
==Overview==
Typically for a patient with progressed cirrhosis of the liver, transplantation may be the only viable treatment. If transplantation is not possible or desired, a patient may undergo the TIPS procedure which has demonstrated a great deal of success.
[[Patient|Patients]] with decompensated [[Cirrhosis|liver cirrhosis]] are  usually candidates for [[liver transplantation]]. [[Liver transplantation]] may be carried out based on [[MELD Score|MELD score]] and assessment of the patient’s quality of life, absence of contraindications and [[disease]] severity. In cases where [[Liver transplantation|transplantation]] is contraindicated, a [[patient]] may undergo the [[Transjugular intrahepatic portosystemic shunt|TIPS]] procedure.  A [[transjugular intrahepatic portosystemic shunt]], also [[Transjugular intrahepatic portosystemic shunt|TIPS]], is an artificial channel in the liver from the [[portal vein]] to a [[hepatic vein]], created via the [[jugular vein]]. The main purpose of the [[Transjugular intrahepatic portosystemic shunt|TIPS]] procedure is to decompress the [[portal vein]] which would in turn help to prevent rebleeding from [[varices]], and also prevent [[ascites]] formation. [[Transjugular intrahepatic portosystemic shunt|TIPS]] is used to treat [[portal hypertension]] which is often due to [[cirrhosis]].


==Surgery==
==Surgery==
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{{main|Liver transplantation}}
{{main|Liver transplantation}}
If complications cannot be controlled or when the liver ceases functioning, [[liver transplantation]] is necessary. Survival from liver transplantation has been improving over the 1990s, and the five-year survival rate is now around 80%, depending largely on the severity of disease and other medical problems in the recipient.<ref> [http://www.emedicinehealth.com/liver_transplant/page11_em.htmE-medicine liver transplant outlook and survival rates]</ref> In the United States, the [[Model for End-Stage Liver Disease|MELD score]] <ref name="pmid2682175">{{cite journal |author=Cosby RL, Yee B, Schrier RW |title=New classification with prognostic value in cirrhotic patients |journal=Mineral and electrolyte metabolism |volume=15 |issue=5 |pages=261-6 |year=1989 |pmid=2682175 |doi=}}</ref> is used to prioritize patients for transplantation. Transplantation necessitates the use of immune suppressants ([[ciclosporin]] or [[tacrolimus]]).
* Patients with decompensated [[cirrhosis]] (having complications such as [[encephalopathy]], [[ascites]], [[Esophageal varices|variceal]] [[Bleeding|hemorrhage]], [[hepatorenal syndrome]] or compromised [[Liver|hepatic]] function) are treated with [[liver transplantation]].<ref name="pmid811651">{{cite journal |vauthors=Hoganson DA, Irgens RL, Doi RH, Stahly DP |title=Bacterial sporulation and regulation of dihydrodipicolinate synthase in ribonucleic acid polymerase mutants of Bacillus subtilis |journal=J. Bacteriol. |volume=124 |issue=3 |pages=1628–9 |year=1975 |pmid=811651 |pmc=236086 |doi= |url=}}</ref><ref name="pmid15834937">{{cite journal |vauthors=Alessandria C, Ozdogan O, Guevara M, Restuccia T, Jiménez W, Arroyo V, Rodés J, Ginès P |title=MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation |journal=Hepatology |volume=41 |issue=6 |pages=1282–9 |year=2005 |pmid=15834937 |doi=10.1002/hep.20687 |url=}}</ref>
 
* [[Liver transplantation]] may be carried out after assessment of the patient’s quality of life, absence of contraindications and disease severity.<ref name="pmid18190658">{{cite journal |vauthors=Schaubel DE, Sima CS, Goodrich NP, Feng S, Merion RM |title=The survival benefit of deceased donor liver transplantation as a function of candidate disease severity and donor quality |journal=Am. J. Transplant. |volume=8 |issue=2 |pages=419–25 |year=2008 |pmid=18190658 |doi=10.1111/j.1600-6143.2007.02086.x |url=}}</ref><ref name="pmid19009713">{{cite journal |vauthors=Volk ML, Lok AS, Pelletier SJ, Ubel PA, Hayward RA |title=Impact of the model for end-stage liver disease allocation policy on the use of high-risk organs for liver transplantation |journal=Gastroenterology |volume=135 |issue=5 |pages=1568–74 |year=2008 |pmid=19009713 |doi= |url=}}</ref><ref name="pmid14999695">{{cite journal |vauthors=Kremers WK, van IJperen M, Kim WR, Freeman RB, Harper AM, Kamath PS, Wiesner RH |title=MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients |journal=Hepatology |volume=39 |issue=3 |pages=764–9 |year=2004 |pmid=14999695 |doi=10.1002/hep.20083 |url=}}</ref><ref name="pmid17326205">{{cite journal |vauthors=Schmidt LE, Larsen FS |title=MELD score as a predictor of liver failure and death in patients with acetaminophen-induced liver injury |journal=Hepatology |volume=45 |issue=3 |pages=789–96 |year=2007 |pmid=17326205 |doi=10.1002/hep.21503 |url=}}</ref><ref name="pmid21898487">{{cite journal |vauthors=Sharma P, Schaubel DE, Gong Q, Guidinger M, Merion RM |title=End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates |journal=Hepatology |volume=55 |issue=1 |pages=192–8 |year=2012 |pmid=21898487 |pmc=3235236 |doi=10.1002/hep.24632 |url=}}</ref><ref name="pmid16244547">{{cite journal |vauthors=Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, Shames BD, Becker YT, Odorico JS, Knechtle SJ, Sollinger HW, Kalayoglu M, D'Alessandro AM |title=Donation after cardiac death: the University of Wisconsin experience with liver transplantation |journal=Ann. Surg. |volume=242 |issue=5 |pages=724–31 |year=2005 |pmid=16244547 |pmc=1409855 |doi= |url=}}</ref>
* The evaluation of a [[patient]] with [[cirrhosis]] for transplantation begins once the [[MELD Score|MELD score]] is >10. This provides an adequate window for pre-transplanation evaluation.<ref name="pmid15834937">{{cite journal |vauthors=Alessandria C, Ozdogan O, Guevara M, Restuccia T, Jiménez W, Arroyo V, Rodés J, Ginès P |title=MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation |journal=Hepatology |volume=41 |issue=6 |pages=1282–9 |year=2005 |pmid=15834937 |doi=10.1002/hep.20687 |url=}}</ref><ref name="pmid14999695">{{cite journal |vauthors=Kremers WK, van IJperen M, Kim WR, Freeman RB, Harper AM, Kamath PS, Wiesner RH |title=MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients |journal=Hepatology |volume=39 |issue=3 |pages=764–9 |year=2004 |pmid=14999695 |doi=10.1002/hep.20083 |url=}}</ref><ref name="pmid17326205">{{cite journal |vauthors=Schmidt LE, Larsen FS |title=MELD score as a predictor of liver failure and death in patients with acetaminophen-induced liver injury |journal=Hepatology |volume=45 |issue=3 |pages=789–96 |year=2007 |pmid=17326205 |doi=10.1002/hep.21503 |url=}}</ref><ref name="pmid15158328">{{cite journal |vauthors=Said A, Williams J, Holden J, Remington P, Gangnon R, Musat A, Lucey MR |title=Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease |journal=J. Hepatol. |volume=40 |issue=6 |pages=897–903 |year=2004 |pmid=15158328 |doi=10.1016/j.jhep.2004.02.010 |url=}}</ref><ref name="pmid18250126">{{cite journal |vauthors=Bambha K, Kim WR, Pedersen R, Bida JP, Kremers WK, Kamath PS |title=Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis |journal=Gut |volume=57 |issue=6 |pages=814–20 |year=2008 |pmid=18250126 |doi=10.1136/gut.2007.137489 |url=}}</ref><ref name="pmid24148622">{{cite journal |vauthors=Reverter E, Tandon P, Augustin S, Turon F, Casu S, Bastiampillai R, Keough A, Llop E, González A, Seijo S, Berzigotti A, Ma M, Genescà J, Bosch J, García-Pagán JC, Abraldes JG |title=A MELD-based model to determine risk of mortality among patients with acute variceal bleeding |journal=Gastroenterology |volume=146 |issue=2 |pages=412–19.e3 |year=2014 |pmid=24148622 |doi=10.1053/j.gastro.2013.10.018 |url=}}</ref><ref name="pmid21576598">{{cite journal |vauthors=Inaba K, Barmparas G, Resnick S, Browder T, Chan LS, Lam L, Talving P, Demetriades D |title=The Model for End-Stage Liver Disease score: an independent prognostic factor of mortality in injured cirrhotic patients |journal=Arch Surg |volume=146 |issue=9 |pages=1074–8 |year=2011 |pmid=21576598 |doi=10.1001/archsurg.2011.109 |url=}}</ref><ref name="pmid11981782">{{cite journal |vauthors=Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, Pandya P, Sitaraman S, Shen J |title=Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding |journal=Hepatology |volume=35 |issue=5 |pages=1282–4 |year=2002 |pmid=11981782 |doi=10.1053/jhep.2002.32532 |url=}}</ref><ref name="pmid15885352">{{cite journal |vauthors=Amitrano L, Guardascione MA, Bennato R, Manguso F, Balzano A |title=MELD score and hepatocellular carcinoma identify patients at different risk of short-term mortality among cirrhotics bleeding from esophageal varices |journal=J. Hepatol. |volume=42 |issue=6 |pages=820–5 |year=2005 |pmid=15885352 |doi=10.1016/j.jhep.2005.01.021 |url=}}</ref><ref name="pmid23563127">{{cite journal |vauthors=Kim MS, Kato TS, Farr M, Wu C, Givens RC, Collado E, Mancini DM, Schulze PC |title=Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction |journal=J. Am. Coll. Cardiol. |volume=61 |issue=22 |pages=2253–2261 |year=2013 |pmid=23563127 |pmc=3939720 |doi=10.1016/j.jacc.2012.12.056 |url=}}</ref>
* [[Patient|Patients]] typically become candidates for [[liver transplantation]] once the [[MELD Score|MELD score]] is  ≥15, but this may not leave enough time for [[patient]] education and counseling, especially in cases where [[hepatic encephalopathy]] sets in. <ref name="pmid14755772">{{cite journal |vauthors=Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R |title=Results of the first year of the new liver allocation plan |journal=Liver Transpl. |volume=10 |issue=1 |pages=7–15 |year=2004 |pmid=14755772 |doi=10.1002/lt.20024 |url=}}</ref><ref name="pmid23775946">{{cite journal |vauthors=Cejas NG, Villamil FG, Lendoire JC, Tagliafichi V, Lopez A, Krogh DH, Soratti CA, Bisigniano L |title=Improved waiting-list outcomes in Argentina after the adoption of a model for end-stage liver disease-based liver allocation policy |journal=Liver Transpl. |volume=19 |issue=7 |pages=711–20 |year=2013 |pmid=23775946 |doi=10.1002/lt.23665 |url=}}</ref><ref name="pmid16041215">{{cite journal |vauthors=Northup PG, Wanamaker RC, Lee VD, Adams RB, Berg CL |title=Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis |journal=Ann. Surg. |volume=242 |issue=2 |pages=244–51 |year=2005 |pmid=16041215 |pmc=1357730 |doi= |url=}}</ref><ref name="pmid17408652">{{cite journal |vauthors=Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ, Talwalkar JA, Kim WR, Kamath PS |title=Risk factors for mortality after surgery in patients with cirrhosis |journal=Gastroenterology |volume=132 |issue=4 |pages=1261–9 |year=2007 |pmid=17408652 |doi=10.1053/j.gastro.2007.01.040 |url=}}</ref><ref name="pmid11804670">{{cite journal |vauthors=Veldt BJ, Lainé F, Guillygomarc'h A, Lauvin L, Boudjema K, Messner M, Brissot P, Deugnier Y, Moirand R |title=Indication of liver transplantation in severe alcoholic liver cirrhosis: quantitative evaluation and optimal timing |journal=J. Hepatol. |volume=36 |issue=1 |pages=93–8 |year=2002 |pmid=11804670 |doi= |url=}}</ref>
*  Patients qualify as candidates for [[liver transplantation]] irrespective of their [[MELD Score|MELD score]] in the following conditions: <ref name="pmid19033587">{{cite journal |vauthors=Moylan CA, Brady CW, Johnson JL, Smith AD, Tuttle-Newhall JE, Muir AJ |title=Disparities in liver transplantation before and after introduction of the MELD score |journal=JAMA |volume=300 |issue=20 |pages=2371–8 |year=2008 |pmid=19033587 |pmc=3640479 |doi=10.1001/jama.2008.720 |url=}}</ref><ref name="pmid17217437">{{cite journal |vauthors=Cholongitas E, Marelli L, Kerry A, Goodier DW, Nair D, Thomas M, Patch D, Burroughs AK |title=Female liver transplant recipients with the same GFR as male recipients have lower MELD scores--a systematic bias |journal=Am. J. Transplant. |volume=7 |issue=3 |pages=685–92 |year=2007 |pmid=17217437 |doi=10.1111/j.1600-6143.2007.01666.x |url=}}</ref><ref name="pmid18685308">{{cite journal |vauthors=Bambha KM, Biggins SW |title=Inequities of the Model for End-Stage Liver Disease: an examination of current components and future additions |journal=Curr Opin Organ Transplant |volume=13 |issue=3 |pages=227–33 |year=2008 |pmid=18685308 |doi=10.1097/MOT.0b013e3282ff84c7 |url=}}</ref>
** [[Hepatic artery]] [[thrombosis]]
** [[Hilum|Hilar]] [[cholangiocarcinoma]]
** [[Hepatocellular carcinoma|HCC]]
** [[Hepatopulmonary syndrome]]
** Refractory [[ascites]], [[hepatic encephalopathy]] or [[Esophageal varices|variceal]] [[Bleeding|hemorrhage]]
** [[Portal hypertensive gastropathy]] 
** Intractable [[Itch|pruritus]] in a patient with [[primary biliary cirrhosis]]
** [[Cystic fibrosis]]
** [[Primary hyperoxaluria]]
** [[Familial amyloid polyneuropathy]]
* Survival from [[liver transplantation]] has been improving over the 1990s, and the five-year survival rate is now around 80%, depending largely on the severity of disease and medical [[Comorbidity|comorbidities]] in the recipient.<ref>[http://www.emedicinehealth.com/liver_transplant/page11_em.htmE-medicine liver transplant outlook and survival rates]</ref>  
* In the United States, the [[Model for End-Stage Liver Disease|MELD score]] is used to prioritize patients for [[liver transplantation]].<ref name="pmid2682175">{{cite journal |author=Cosby RL, Yee B, Schrier RW |title=New classification with prognostic value in cirrhotic patients |journal=Mineral and electrolyte metabolism |volume=15 |issue=5 |pages=261-6 |year=1989 |pmid=2682175 |doi=}}</ref>
* [[Organ transplant|Transplantation]] necessitates the use of [[Immunosuppressive drug|immunosuppressants]] ([[cyclosporine]] or [[tacrolimus]]).<ref name="pmid7523946">{{cite journal |vauthors= |title=A comparison of tacrolimus (FK 506) and cyclosporine for immunosuppression in liver transplantation |journal=N. Engl. J. Med. |volume=331 |issue=17 |pages=1110–5 |year=1994 |pmid=7523946 |doi=10.1056/NEJM199410273311702 |url=}}</ref><ref name="urlDefining the outcome of immunosuppression withdrawal after liver transplantation - Devlin - 2003 - Hepatology - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1002/hep.510270406/pdf |title=Defining the outcome of immunosuppression withdrawal after liver transplantation - Devlin - 2003 - Hepatology - Wiley Online Library |format= |work= |accessdate=}}</ref><ref name="pmid7520105">{{cite journal |vauthors= |title=Randomised trial comparing tacrolimus (FK506) and cyclosporin in prevention of liver allograft rejection. European FK506 Multicentre Liver Study Group |journal=Lancet |volume=344 |issue=8920 |pages=423–8 |year=1994 |pmid=7520105 |doi= |url=}}</ref><ref name="pmid15719409">{{cite journal |vauthors=Fung J, Kelly D, Kadry Z, Patel-Tom K, Eghtesad B |title=Immunosuppression in liver transplantation: beyond calcineurin inhibitors |journal=Liver Transpl. |volume=11 |issue=3 |pages=267–80 |year=2005 |pmid=15719409 |doi=10.1002/lt.20373 |url=}}</ref><ref name="pmid15606606">{{cite journal |vauthors=Perry I, Neuberger J |title=Immunosuppression: towards a logical approach in liver transplantation |journal=Clin. Exp. Immunol. |volume=139 |issue=1 |pages=2–10 |year=2005 |pmid=15606606 |pmc=1809260 |doi=10.1111/j.1365-2249.2005.02662.x |url=}}</ref>
;Prevalence
;Prevalence
 
* Patients with [[primary biliary cirrhosis]] treated with [[ursodeoxycholic acid]] (UDCA) have decreased need for [[liver transplantation]].<ref name="pmid17900996">{{cite journal |author=Lee J, Belanger A, Doucette JT, Stanca C, Friedman S, Bach N |title=Transplantation trends in primary biliary cirrhosis |journal=[[Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association]] |volume=5 |issue=11 |pages=1313–5 |year=2007 |pmid=17900996 |doi=10.1016/j.cgh.2007.07.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S1542-3565(07)00718-5 |accessdate=2012-09-06}}</ref>
A recent study was completed between 1995 and 2006 that sought out to determine if there was a correlation between [[ursodeoxycholic acid]] (UDCA) and a decreases in liver transplantations for treating primary biliary cirrhosis.<ref name="pmid17900996">{{cite journal |author=Lee J, Belanger A, Doucette JT, Stanca C, Friedman S, Bach N |title=Transplantation trends in primary biliary cirrhosis |journal=[[Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association]] |volume=5 |issue=11 |pages=1313–5 |year=2007 |month=November |pmid=17900996 |doi=10.1016/j.cgh.2007.07.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S1542-3565(07)00718-5 |accessdate=2012-09-06}}</ref> In 2006 the results showed that over a ten year period the amount of liver transplantations needed for people with cirrhosis decreased by an average of 5.4 cases per year.<ref name="pmid17900996">{{cite journal |author=Lee J, Belanger A, Doucette JT, Stanca C, Friedman S, Bach N |title=Transplantation trends in primary biliary cirrhosis |journal=[[Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association]] |volume=5 |issue=11 |pages=1313–5 |year=2007 |month=November |pmid=17900996 |doi=10.1016/j.cgh.2007.07.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S1542-3565(07)00718-5 |accessdate=2012-09-06}}</ref> Although no causal relationship has been confirmed, this study has shown strong support to the notion that UDCA use has decreased the need for [[liver transplantation]] in patients presenting with primary biliary cirrhosis.<ref name="pmid17900996">{{cite journal |author=Lee J, Belanger A, Doucette JT, Stanca C, Friedman S, Bach N |title=Transplantation trends in primary biliary cirrhosis |journal=[[Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association]] |volume=5 |issue=11 |pages=1313–5 |year=2007 |month=November |pmid=17900996 |doi=10.1016/j.cgh.2007.07.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S1542-3565(07)00718-5 |accessdate=2012-09-06}}</ref>
 
;Symptoms After Surgery
;Symptoms After Surgery
 
* Complications of end stage [[liver]] disease present before [[Liver transplantation|transplantation]] are typically resolved after the surgery.
Complications of end stage liver disease that were present before transplantation are typically resolved after the surgery. Complications such as [[variceal bleeding]], [[encephalopathy]], and [[hepatorenal syndrome]] are usually resolved after a successful transplantation. [[Pruritis]], which can be associated with cirrhosis, is typically cleared up post-surgery.
* Complications such as [[variceal bleeding]], [[encephalopathy]], and [[hepatorenal syndrome]] are usually resolved after a successful [[Liver transplantation|transplantation]].
 
* [[Pruritis]], which may be associated with [[cirrhosis]], is typically cleared up post-surgery.
;Survival
;Survival
 
* [[Liver transplantation]] may have a significant effect on the long term survival of the [[patient]].<ref name="pmid22030293">{{cite journal |vauthors=Salpeter SR, Luo EJ, Malter DS, Stuart B |title=Systematic review of noncancer presentations with a median survival of 6 months or less |journal=Am. J. Med. |volume=125 |issue=5 |pages=512.e1–6 |year=2012 |pmid=22030293 |doi=10.1016/j.amjmed.2011.07.028 |url=}}</ref><ref name="pmid26161590">{{cite journal |vauthors=Askgaard G, Tolstrup JS, Gerds TA, Hamberg O, Zierau L, Kjær MS |title=Predictors of heavy drinking after liver transplantation for alcoholic liver disease in Denmark (1990-2013): a nationwide study with competing risks analyses |journal=Scand. J. Gastroenterol. |volume=51 |issue=2 |pages=225–35 |year=2016 |pmid=26161590 |doi=10.3109/00365521.2015.1067903 |url=}}</ref><ref name="pmid15382215">{{cite journal |vauthors=Merion RM |title=When is a patient too well and when is a patient too sick for a liver transplant? |journal=Liver Transpl. |volume=10 |issue=10 Suppl 2 |pages=S69–73 |year=2004 |pmid=15382215 |doi=10.1002/lt.20265 |url=}}</ref><ref name="pmid14685105">{{cite journal |vauthors=Abt PL, Desai NM, Crawford MD, Forman LM, Markmann JW, Olthoff KM, Markmann JF |title=Survival following liver transplantation from non-heart-beating donors |journal=Ann. Surg. |volume=239 |issue=1 |pages=87–92 |year=2004 |pmid=14685105 |pmc=1356197 |doi=10.1097/01.sla.0000103063.82181.2c |url=}}</ref><ref name="pmid15237373">{{cite journal |vauthors=Roberts MS, Angus DC, Bryce CL, Valenta Z, Weissfeld L |title=Survival after liver transplantation in the United States: a disease-specific analysis of the UNOS database |journal=Liver Transpl. |volume=10 |issue=7 |pages=886–97 |year=2004 |pmid=15237373 |doi=10.1002/lt.20137 |url=}}</ref>
In cases in which transplantation is indicated for a patient with cirrhosis, transplantation can have a significant effect on the long term survival of the patient. A study conducted between 1982 and 1999 researched 400 patients who underwent liver transplants due to end stage cirrhosis.<ref name="pmid11124816">{{cite journal |author=Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J |title=Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center |journal=[[Hepatology (Baltimore, Md.)]] |volume=33 |issue=1 |pages=22–7 |year=2001 |month=January |pmid=11124816 |doi=10.1053/jhep.2001.20894 |url=http://dx.doi.org/10.1053/jhep.2001.20894 |accessdate=2012-09-06}}</ref> The patients in the study are indicated for surgery because either their quality of life is significantly poor or they are not projected to survive longer than a year. The overall survival rates from this particular study demonstrate a significant increase in the amount of years a patient with cirrhosis can survive. For the entire study, the overall survival rate at 1 year post surgery was 87%, at 5 years post surgery was 78%, and at 10 years post surgery was 67%.<ref name="pmid11124816">{{cite journal |author=Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J |title=Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center |journal=[[Hepatology (Baltimore, Md.)]] |volume=33 |issue=1 |pages=22–7 |year=2001 |month=January |pmid=11124816 |doi=10.1053/jhep.2001.20894 |url=http://dx.doi.org/10.1053/jhep.2001.20894 |accessdate=2012-09-06}}</ref> Since this study occurred in the 1980s as well as the 1990s, the data was further broken down to show the significant improvements that have been made in transplantation more recently. In the 1980s the survival rate at 1 year post surgery was 72%, at 3 years post surgery was 70%, and at 5 years post surgery was 66%.<ref name="pmid11124816">{{cite journal |author=Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J |title=Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center |journal=[[Hepatology (Baltimore, Md.)]] |volume=33 |issue=1 |pages=22–7 |year=2001 |month=January |pmid=11124816 |doi=10.1053/jhep.2001.20894 |url=http://dx.doi.org/10.1053/jhep.2001.20894 |accessdate=2012-09-06}}</ref> On the contrary, in the 1990s the survival rate at 1 year post surgery was 87%, at 3 years post surgery was 83%, and at 5 years post surgery was 80%.<ref name="pmid11124816">{{cite journal |author=Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J |title=Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center |journal=[[Hepatology (Baltimore, Md.)]] |volume=33 |issue=1 |pages=22–7 |year=2001 |month=January |pmid=11124816 |doi=10.1053/jhep.2001.20894 |url=http://dx.doi.org/10.1053/jhep.2001.20894 |accessdate=2012-09-06}}</ref>
* The overall [[Survival rate|survival rates]] of patients have demonstrated a significant increase in [[Patient|patients]] post [[Liver transplantation|transplantation]]. The overall post-surgical [[survival rate]] at 1,5 and 10 years  is 87%,80%, and 67% respectively.<ref name="pmid11124816">{{cite journal |author=Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J |title=Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center |journal=[[Hepatology (Baltimore, Md.)]] |volume=33 |issue=1 |pages=22–7 |year=2001 |pmid=11124816 |doi=10.1053/jhep.2001.20894 |url=http://dx.doi.org/10.1053/jhep.2001.20894 |accessdate=2012-09-06}}</ref>
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===TIPS (Transjugular Intrahepatic Portosystemic Shunt)===
===TIPS (Transjugular Intrahepatic Portosystemic Shunt)===


{{main|Transjugular intrahepatic portosystemic shunt}}
{{main|Transjugular intrahepatic portosystemic shunt}}
 
* A [[transjugular intrahepatic portosystemic shunt]], also [[Transjugular intrahepatic portosystemic shunt|TIPS]], is an artificial channel in the liver from the [[portal vein]] to a [[hepatic vein]], created via the [[jugular vein]].<ref name="pmid7918921">{{cite journal |vauthors=McCormick PA, Dick R, Burroughs AK |title=Review article: the transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension |journal=Aliment. Pharmacol. Ther. |volume=8 |issue=3 |pages=273–82 |year=1994 |pmid=7918921 |doi= |url=}}</ref><ref name="pmid24115809">{{cite journal |vauthors=Loffroy R, Estivalet L, Cherblanc V, Favelier S, Pottecher P, Hamza S, Minello A, Hillon P, Thouant P, Lefevre PH, Krausé D, Cercueil JP |title=Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage |journal=World J. Gastroenterol. |volume=19 |issue=37 |pages=6131–43 |year=2013 |pmid=24115809 |pmc=3787342 |doi=10.3748/wjg.v19.i37.6131 |url=}}</ref>
A transjugular intrahepatic portosystemic shunt, also TIPS, is an artificial channel in the liver from the [[portal vein]] to a [[hepatic vein]] (for blood).  It is created [[endovascularly]] (via the [[blood vessels]]) via the [[jugular vein]]. It's main purpose is to decompress the portal vein which would in turn help to prevent rebleeding from [[varices]], and it could also prevent [[ascites]] formation.<ref name="pmid15660434">{{cite journal |author=Boyer TD, Haskal ZJ |title=The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension |journal=[[Hepatology (Baltimore, Md.)]] |volume=41 |issue=2 |pages=386–400 |year=2005 |month=February |pmid=15660434 |doi=10.1002/hep.20559 |url=http://dx.doi.org/10.1002/hep.20559 |accessdate=2012-09-06}}</ref> In most cases, the success rate for the decompression of the [[portal vein]] is quite high at more than 90%.<ref name="pmid15660434">{{cite journal |author=Boyer TD, Haskal ZJ |title=The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension |journal=[[Hepatology (Baltimore, Md.)]] |volume=41 |issue=2 |pages=386–400 |year=2005 |month=February |pmid=15660434 |doi=10.1002/hep.20559 |url=http://dx.doi.org/10.1002/hep.20559 |accessdate=2012-09-06}}</ref>
* The main purpose of the [[Transjugular intrahepatic portosystemic shunt|TIPS]] procedure is to decompress the [[portal vein]] which would in turn help to prevent rebleeding from [[varices]], and also prevent [[ascites]] formation.<ref name="pmid15660434">{{cite journal |author=Boyer TD, Haskal ZJ |title=The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension |journal=[[Hepatology (Baltimore, Md.)]] |volume=41 |issue=2 |pages=386–400 |year=2005 |pmid=15660434 |doi=10.1002/hep.20559 |url=http://dx.doi.org/10.1002/hep.20559 |accessdate=2012-09-06}}</ref>  
 
;Indications
;Indications
 
* [[Transjugular intrahepatic portosystemic shunt|TIPS]] is used to treat [[portal hypertension]] which is often due to [[cirrhosis]].  
It is used to treat [[portal hypertension]] which is often due to cirrhosis. The scar tissue that is present on the liver due to cirrhosis causes blockages, which in turn causes [[hypertension]] within the [[portal vein]]. Because of the increased pressure in the portal vein, blood flows preferentially towards organs in the stomach that would typically drain into the portal vein. These veins that are bypassing the liver and filling with blood in the [[abdomen]] may rupture. The possibility of rupture makes a transjugular intrahepatic portosystemic shunt a benificial procedure.
* The scar tissue in the [[liver]] due to [[cirrhosis]] causes blockages in the [[portal vein]], leading to  [[portal vein]] [[hypertension]].
 
* Due to the increased pressure in the [[portal vein]], veins that are bypassing the [[liver]] may rupture. The possibility of rupture makes a [[transjugular intrahepatic portosystemic shunt]] a beneficial procedure.
;Contraindications
;Contraindications
 
* Absolute contraindications:<ref name="pmid15660434">{{cite journal |author=Boyer TD, Haskal ZJ |title=The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension |journal=[[Hepatology (Baltimore, Md.)]] |volume=41 |issue=2 |pages=386–400 |year=2005 |pmid=15660434 |doi=10.1002/hep.20559 |url=http://dx.doi.org/10.1002/hep.20559 |accessdate=2012-09-06}}</ref>
Not all patients with cirrhosis are eligible for the TIPS procedure. There are some conditions in which the patient would be absolutely contraindicated from undergoing the TIPS procedure, and there are some in which the patient would be relatively contraindicated. Some of the absolute contraindications include [[congestive heart failure]], uncontrolled [[sepsis]], uncontrolled [[systemic infection]], unrelieved [[biliary obstruction]], multiple [[hepatic cysts]], and severe [[pulmonary hypertension]].<ref name="pmid15660434">{{cite journal |author=Boyer TD, Haskal ZJ |title=The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension |journal=[[Hepatology (Baltimore, Md.)]] |volume=41 |issue=2 |pages=386–400 |year=2005 |month=February |pmid=15660434 |doi=10.1002/hep.20559 |url=http://dx.doi.org/10.1002/hep.20559 |accessdate=2012-09-06}}</ref> Some of the relative contraindications include [[hepatoma]], severe [[coagulopathy]], [[portal vein]] [[thrombosis]], blockage of all the [[hepatic veins]], moderate [[pulmonary hypertension]], and [[thrombocytopenia]].<ref name="pmid15660434">{{cite journal |author=Boyer TD, Haskal ZJ |title=The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension |journal=[[Hepatology (Baltimore, Md.)]] |volume=41 |issue=2 |pages=386–400 |year=2005 |month=February |pmid=15660434 |doi=10.1002/hep.20559 |url=http://dx.doi.org/10.1002/hep.20559 |accessdate=2012-09-06}}</ref>
** [[congestive heart failure]]  
 
** Uncontrolled [[sepsis]]  
** Uncontrolled [[systemic infection]]  
** Unresolved [[biliary obstruction]]  
** Multiple [[hepatic cysts]]  
** Severe [[pulmonary hypertension]]  
* Relative contraindications:<ref name="pmid15660434">{{cite journal |author=Boyer TD, Haskal ZJ |title=The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension |journal=[[Hepatology (Baltimore, Md.)]] |volume=41 |issue=2 |pages=386–400 |year=2005 |pmid=15660434 |doi=10.1002/hep.20559 |url=http://dx.doi.org/10.1002/hep.20559 |accessdate=2012-09-06}}</ref>
** [[Hepatoma]]
** Severe [[coagulopathy]]
** Portal vein [[thrombosis]]
** [[hepatic veins|Hepatic vein]] [[thrombosis]]
** Moderate [[pulmonary hypertension]]
** [[Thrombocytopenia]]
;Survival
;Survival
 
* [[Transjugular intrahepatic portosystemic shunt|TIPS]] procedure has a 30-day mortality rate of 45% for people that need an emergency [[portacaval shunt]].<ref name="pmid8290720">{{cite journal |author=Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP |title=Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review |journal=[[Radiographics : a Review Publication of the Radiological Society of North America, Inc]] |volume=13 |issue=6 |pages=1185–210 |year=1993 |pmid=8290720 |doi= |url=http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=8290720 |accessdate=2012-09-06}}</ref><ref name="pmid23198995">{{cite journal |vauthors=Senanayake SM, Niriella MA, Weerasinghe SK, Kasturiratne A, de Alwis JP, de Silva AP, Dassanayake AS, de Silva HJ |title=Survival of patients with alcoholic and cryptogenic cirrhosis without liver transplantation: a single center retrospective study |journal=BMC Res Notes |volume=5 |issue= |pages=663 |year=2012 |pmid=23198995 |pmc=3543705 |doi=10.1186/1756-0500-5-663 |url=}}</ref>  
Compared to other procedures, the TIPS procedure appears to be a safe option for people with [[portal hypertension]] due to cirrhosis. The TIPS procedure has a 30-day mortality rate of 45% for people that need an emergency portacaval shunt.<ref name="pmid8290720">{{cite journal |author=Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP |title=Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review |journal=[[Radiographics : a Review Publication of the Radiological Society of North America, Inc]] |volume=13 |issue=6 |pages=1185–210 |year=1993 |month=November |pmid=8290720 |doi= |url=http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=8290720 |accessdate=2012-09-06}}</ref> Typically, the survival rate is substantially less. The mortality rate directly due to the TIPS procedure itself is less than 2%. Some of these causes of death include [[myocardial infarctions]] during the procedure as well as an [[intraperitoneal hemorrhage]] due to a rupture or puncture of the [[portal vein]].<ref name="pmid8290720">{{cite journal |author=Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP |title=Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review |journal=[[Radiographics : a Review Publication of the Radiological Society of North America, Inc]] |volume=13 |issue=6 |pages=1185–210 |year=1993 |month=November |pmid=8290720 |doi= |url=http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=8290720 |accessdate=2012-09-06}}</ref> These complications are rare and many of the people that die from this procedure have some sort of bleeding occurring before the procedure even begins.<ref name="pmid8290720">{{cite journal |author=Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP |title=Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review |journal=[[Radiographics : a Review Publication of the Radiological Society of North America, Inc]] |volume=13 |issue=6 |pages=1185–210 |year=1993 |month=November |pmid=8290720 |doi= |url=http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=8290720 |accessdate=2012-09-06}}</ref>
* The mortality rate due to the [[Transjugular intrahepatic portosystemic shunt|TIPS]] procedure itself is less than 2%.
 
* Some of the causes of death associated with [[Transjugular intrahepatic portosystemic shunt|TIPS]] include [[myocardial infarctions|myocardial infarction]] during the procedure and [[Peritoneum|intraperitoneal]] [[Bleeding|hemorrhage]] due to a rupture or puncture of the [[portal vein]].<ref name="pmid8290720">{{cite journal |author=Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP |title=Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review |journal=[[Radiographics : a Review Publication of the Radiological Society of North America, Inc]] |volume=13 |issue=6 |pages=1185–210 |year=1993 |pmid=8290720 |doi= |url=http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=8290720 |accessdate=2012-09-06}}</ref>  
;Complications
;Complications
 
* Complications of [[Transjugular intrahepatic portosystemic shunt|TIPS]] include puncture and dilation of the [[portal vein]], [[hematoma]] at the puncture site and [[thrombosis]] of the [[stent]] that is placed in the [[hepatic vein]] during the procedure.<ref name="pmid8290720">{{cite journal |author=Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP |title=Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review |journal=[[Radiographics : a Review Publication of the Radiological Society of North America, Inc]] |volume=13 |issue=6 |pages=1185–210 |year=1993 |month=November |pmid=8290720 |doi= |url=http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=8290720 |accessdate=2012-09-06}}</ref>  
Although the TIPS procedure is a less invasive alternate to transplantation, there are some complications that may be present. Complications involving the puncture of the [[portal vein]] have been previously noted. It is possible for there to be [[hemorrhage]] or [[hematoma]] from the puncture site.<ref name="pmid8290720">{{cite journal |author=Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP |title=Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review |journal=[[Radiographics : a Review Publication of the Radiological Society of North America, Inc]] |volume=13 |issue=6 |pages=1185–210 |year=1993 |month=November |pmid=8290720 |doi= |url=http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=8290720 |accessdate=2012-09-06}}</ref> There are also complications associated with the [[dilation]] of the portal vein. There is a high likelihood of death if this portion of the procedure does not go correctly.<ref name="pmid8290720">{{cite journal |author=Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP |title=Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review |journal=[[Radiographics : a Review Publication of the Radiological Society of North America, Inc]] |volume=13 |issue=6 |pages=1185–210 |year=1993 |month=November |pmid=8290720 |doi= |url=http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=8290720 |accessdate=2012-09-06}}</ref> There is also a possibility of there being [[thrombosis]] of the [[stent]] that is placed in the [[hepatic vein]] during the procedure.<ref name="pmid8290720">{{cite journal |author=Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP |title=Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review |journal=[[Radiographics : a Review Publication of the Radiological Society of North America, Inc]] |volume=13 |issue=6 |pages=1185–210 |year=1993 |month=November |pmid=8290720 |doi= |url=http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=8290720 |accessdate=2012-09-06}}</ref>
* It is more difficult to perform [[liver transplantation]] after a patient has already undergone the [[Transjugular intrahepatic portosystemic shunt|TIPS]] procedure. Inserting a shunt into the [[liver]] needs to be exceedingly precise in patients that have the possibility of obtaining a new [[liver]]. In transplant cases, patient and [[graft]] survival is worse in individuals that previously had a shunt placed in the [[hepatic vein]].<ref name="pmid15660434">{{cite journal |author=Boyer TD, Haskal ZJ |title=The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension |journal=[[Hepatology (Baltimore, Md.)]] |volume=41 |issue=2 |pages=386–400 |year=2005 |month=February |pmid=15660434 |doi=10.1002/hep.20559 |url=http://dx.doi.org/10.1002/hep.20559 |accessdate=2012-09-06}}</ref>  
 
If the patient going through the TIPS procedure is in line for a liver transplantation, this can further complicate the procedure. Inserting a shunt into the liver needs to be exceedingly precise in patients that have the possibility of obtaining a new liver. In transplant cases, it has been shown in some studies that the patient and [[graft]] survival was somewhat worse in those individuals that previously had a shunt placed in the [[hepatic vein]].<ref name="pmid15660434">{{cite journal |author=Boyer TD, Haskal ZJ |title=The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension |journal=[[Hepatology (Baltimore, Md.)]] |volume=41 |issue=2 |pages=386–400 |year=2005 |month=February |pmid=15660434 |doi=10.1002/hep.20559 |url=http://dx.doi.org/10.1002/hep.20559 |accessdate=2012-09-06}}</ref> It is typically more difficult to perform the transplantation after a patient has already undergone the TIPS procedure.
 
;Drawbacks
;Drawbacks
* Two of the major drawbacks that may be present with the [[Transjugular intrahepatic portosystemic shunt|TIPS]] procedure are [[stent]] dysfunction and portosystemic [[encephalopathy]].<ref name="pmid17975487">{{cite journal |author=Colombato L |title=The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension |journal=[[Journal of Clinical Gastroenterology]] |volume=41 Suppl 3 |issue= |pages=S344–51 |year=2007 |pmid=17975487 |doi=10.1097/MCG.0b013e318157e500 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0192-0790&volume=41&issue=&spage=S344 |accessdate=2012-09-06}}</ref>
* There also may be a frequent need for [[endovascluar]] reintervention to make sure that the [[stent]] remains [[patent]].<ref name="pmid17975487">{{cite journal |author=Colombato L |title=The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension |journal=[[Journal of Clinical Gastroenterology]] |volume=41 Suppl 3 |issue= |pages=S344–51 |year=2007 |pmid=17975487 |doi=10.1097/MCG.0b013e318157e500 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0192-0790&volume=41&issue=&spage=S344 |accessdate=2012-09-06}}</ref>


Two of the major weaknesses that can be present with the TIPS procedure are [[stent]] dysfunction and [[portosystemic encephalopathy]].<ref name="pmid17975487">{{cite journal |author=Colombato L |title=The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension |journal=[[Journal of Clinical Gastroenterology]] |volume=41 Suppl 3 |issue= |pages=S344–51 |year=2007 |pmid=17975487 |doi=10.1097/MCG.0b013e318157e500 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0192-0790&volume=41&issue=&spage=S344 |accessdate=2012-09-06}}</ref> A problem also arises due to the fact that there is a frequent need for [[endovascluar]] reintervention to make sure that the stent remains [[patent]].<ref name="pmid17975487">{{cite journal |author=Colombato L |title=The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension |journal=[[Journal of Clinical Gastroenterology]] |volume=41 Suppl 3 |issue= |pages=S344–51 |year=2007 |pmid=17975487 |doi=10.1097/MCG.0b013e318157e500 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0192-0790&volume=41&issue=&spage=S344 |accessdate=2012-09-06}}</ref>
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==References==
==References==

Latest revision as of 14:36, 27 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Sudarshana Datta, MD [3]

Overview

Patients with decompensated liver cirrhosis are usually candidates for liver transplantation. Liver transplantation may be carried out based on MELD score and assessment of the patient’s quality of life, absence of contraindications and disease severity. In cases where transplantation is contraindicated, a patient may undergo the TIPS procedure. A transjugular intrahepatic portosystemic shunt, also TIPS, is an artificial channel in the liver from the portal vein to a hepatic vein, created via the jugular vein. The main purpose of the TIPS procedure is to decompress the portal vein which would in turn help to prevent rebleeding from varices, and also prevent ascites formation. TIPS is used to treat portal hypertension which is often due to cirrhosis.

Surgery

Transplantation

Main article: Liver transplantation
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Symptoms After Surgery
Survival

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TIPS (Transjugular Intrahepatic Portosystemic Shunt)

Main article: Transjugular intrahepatic portosystemic shunt
Indications
Contraindications
Survival
Complications
  • Complications of TIPS include puncture and dilation of the portal vein, hematoma at the puncture site and thrombosis of the stent that is placed in the hepatic vein during the procedure.[41]
  • It is more difficult to perform liver transplantation after a patient has already undergone the TIPS procedure. Inserting a shunt into the liver needs to be exceedingly precise in patients that have the possibility of obtaining a new liver. In transplant cases, patient and graft survival is worse in individuals that previously had a shunt placed in the hepatic vein.[40]
Drawbacks

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References

  1. ↑ Hoganson DA, Irgens RL, Doi RH, Stahly DP (1975). "Bacterial sporulation and regulation of dihydrodipicolinate synthase in ribonucleic acid polymerase mutants of Bacillus subtilis". J. Bacteriol. 124 (3): 1628–9. PMC 236086. PMID 811651.
  2. ↑ 2.0 2.1 Alessandria C, Ozdogan O, Guevara M, Restuccia T, Jiménez W, Arroyo V, Rodés J, Ginès P (2005). "MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation". Hepatology. 41 (6): 1282–9. doi:10.1002/hep.20687. PMID 15834937.
  3. ↑ Schaubel DE, Sima CS, Goodrich NP, Feng S, Merion RM (2008). "The survival benefit of deceased donor liver transplantation as a function of candidate disease severity and donor quality". Am. J. Transplant. 8 (2): 419–25. doi:10.1111/j.1600-6143.2007.02086.x. PMID 18190658.
  4. ↑ Volk ML, Lok AS, Pelletier SJ, Ubel PA, Hayward RA (2008). "Impact of the model for end-stage liver disease allocation policy on the use of high-risk organs for liver transplantation". Gastroenterology. 135 (5): 1568–74. PMID 19009713.
  5. ↑ 5.0 5.1 Kremers WK, van IJperen M, Kim WR, Freeman RB, Harper AM, Kamath PS, Wiesner RH (2004). "MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients". Hepatology. 39 (3): 764–9. doi:10.1002/hep.20083. PMID 14999695.
  6. ↑ 6.0 6.1 Schmidt LE, Larsen FS (2007). "MELD score as a predictor of liver failure and death in patients with acetaminophen-induced liver injury". Hepatology. 45 (3): 789–96. doi:10.1002/hep.21503. PMID 17326205.
  7. ↑ Sharma P, Schaubel DE, Gong Q, Guidinger M, Merion RM (2012). "End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates". Hepatology. 55 (1): 192–8. doi:10.1002/hep.24632. PMC 3235236. PMID 21898487.
  8. ↑ Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, Shames BD, Becker YT, Odorico JS, Knechtle SJ, Sollinger HW, Kalayoglu M, D'Alessandro AM (2005). "Donation after cardiac death: the University of Wisconsin experience with liver transplantation". Ann. Surg. 242 (5): 724–31. PMC 1409855. PMID 16244547.
  9. ↑ Said A, Williams J, Holden J, Remington P, Gangnon R, Musat A, Lucey MR (2004). "Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease". J. Hepatol. 40 (6): 897–903. doi:10.1016/j.jhep.2004.02.010. PMID 15158328.
  10. ↑ Bambha K, Kim WR, Pedersen R, Bida JP, Kremers WK, Kamath PS (2008). "Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis". Gut. 57 (6): 814–20. doi:10.1136/gut.2007.137489. PMID 18250126.
  11. ↑ Reverter E, Tandon P, Augustin S, Turon F, Casu S, Bastiampillai R, Keough A, Llop E, González A, Seijo S, Berzigotti A, Ma M, Genescà J, Bosch J, García-Pagán JC, Abraldes JG (2014). "A MELD-based model to determine risk of mortality among patients with acute variceal bleeding". Gastroenterology. 146 (2): 412–19.e3. doi:10.1053/j.gastro.2013.10.018. PMID 24148622.
  12. ↑ Inaba K, Barmparas G, Resnick S, Browder T, Chan LS, Lam L, Talving P, Demetriades D (2011). "The Model for End-Stage Liver Disease score: an independent prognostic factor of mortality in injured cirrhotic patients". Arch Surg. 146 (9): 1074–8. doi:10.1001/archsurg.2011.109. PMID 21576598.
  13. ↑ Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, Pandya P, Sitaraman S, Shen J (2002). "Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding". Hepatology. 35 (5): 1282–4. doi:10.1053/jhep.2002.32532. PMID 11981782.
  14. ↑ Amitrano L, Guardascione MA, Bennato R, Manguso F, Balzano A (2005). "MELD score and hepatocellular carcinoma identify patients at different risk of short-term mortality among cirrhotics bleeding from esophageal varices". J. Hepatol. 42 (6): 820–5. doi:10.1016/j.jhep.2005.01.021. PMID 15885352.
  15. ↑ Kim MS, Kato TS, Farr M, Wu C, Givens RC, Collado E, Mancini DM, Schulze PC (2013). "Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction". J. Am. Coll. Cardiol. 61 (22): 2253–2261. doi:10.1016/j.jacc.2012.12.056. PMC 3939720. PMID 23563127.
  16. ↑ Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R (2004). "Results of the first year of the new liver allocation plan". Liver Transpl. 10 (1): 7–15. doi:10.1002/lt.20024. PMID 14755772.
  17. ↑ Cejas NG, Villamil FG, Lendoire JC, Tagliafichi V, Lopez A, Krogh DH, Soratti CA, Bisigniano L (2013). "Improved waiting-list outcomes in Argentina after the adoption of a model for end-stage liver disease-based liver allocation policy". Liver Transpl. 19 (7): 711–20. doi:10.1002/lt.23665. PMID 23775946.
  18. ↑ Northup PG, Wanamaker RC, Lee VD, Adams RB, Berg CL (2005). "Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis". Ann. Surg. 242 (2): 244–51. PMC 1357730. PMID 16041215.
  19. ↑ Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ, Talwalkar JA, Kim WR, Kamath PS (2007). "Risk factors for mortality after surgery in patients with cirrhosis". Gastroenterology. 132 (4): 1261–9. doi:10.1053/j.gastro.2007.01.040. PMID 17408652.
  20. ↑ Veldt BJ, Lainé F, Guillygomarc'h A, Lauvin L, Boudjema K, Messner M, Brissot P, Deugnier Y, Moirand R (2002). "Indication of liver transplantation in severe alcoholic liver cirrhosis: quantitative evaluation and optimal timing". J. Hepatol. 36 (1): 93–8. PMID 11804670.
  21. ↑ Moylan CA, Brady CW, Johnson JL, Smith AD, Tuttle-Newhall JE, Muir AJ (2008). "Disparities in liver transplantation before and after introduction of the MELD score". JAMA. 300 (20): 2371–8. doi:10.1001/jama.2008.720. PMC 3640479. PMID 19033587.
  22. ↑ Cholongitas E, Marelli L, Kerry A, Goodier DW, Nair D, Thomas M, Patch D, Burroughs AK (2007). "Female liver transplant recipients with the same GFR as male recipients have lower MELD scores--a systematic bias". Am. J. Transplant. 7 (3): 685–92. doi:10.1111/j.1600-6143.2007.01666.x. PMID 17217437.
  23. ↑ Bambha KM, Biggins SW (2008). "Inequities of the Model for End-Stage Liver Disease: an examination of current components and future additions". Curr Opin Organ Transplant. 13 (3): 227–33. doi:10.1097/MOT.0b013e3282ff84c7. PMID 18685308.
  24. ↑ liver transplant outlook and survival rates
  25. ↑ Cosby RL, Yee B, Schrier RW (1989). "New classification with prognostic value in cirrhotic patients". Mineral and electrolyte metabolism. 15 (5): 261–6. PMID 2682175.
  26. ↑ "A comparison of tacrolimus (FK 506) and cyclosporine for immunosuppression in liver transplantation". N. Engl. J. Med. 331 (17): 1110–5. 1994. doi:10.1056/NEJM199410273311702. PMID 7523946.
  27. ↑ "Defining the outcome of immunosuppression withdrawal after liver transplantation - Devlin - 2003 - Hepatology - Wiley Online Library".
  28. ↑ "Randomised trial comparing tacrolimus (FK506) and cyclosporin in prevention of liver allograft rejection. European FK506 Multicentre Liver Study Group". Lancet. 344 (8920): 423–8. 1994. PMID 7520105.
  29. ↑ Fung J, Kelly D, Kadry Z, Patel-Tom K, Eghtesad B (2005). "Immunosuppression in liver transplantation: beyond calcineurin inhibitors". Liver Transpl. 11 (3): 267–80. doi:10.1002/lt.20373. PMID 15719409.
  30. ↑ Perry I, Neuberger J (2005). "Immunosuppression: towards a logical approach in liver transplantation". Clin. Exp. Immunol. 139 (1): 2–10. doi:10.1111/j.1365-2249.2005.02662.x. PMC 1809260. PMID 15606606.
  31. ↑ Lee J, Belanger A, Doucette JT, Stanca C, Friedman S, Bach N (2007). "Transplantation trends in primary biliary cirrhosis". Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association. 5 (11): 1313–5. doi:10.1016/j.cgh.2007.07.015. PMID 17900996. Retrieved 2012-09-06.
  32. ↑ Salpeter SR, Luo EJ, Malter DS, Stuart B (2012). "Systematic review of noncancer presentations with a median survival of 6 months or less". Am. J. Med. 125 (5): 512.e1–6. doi:10.1016/j.amjmed.2011.07.028. PMID 22030293.
  33. ↑ Askgaard G, Tolstrup JS, Gerds TA, Hamberg O, Zierau L, Kjær MS (2016). "Predictors of heavy drinking after liver transplantation for alcoholic liver disease in Denmark (1990-2013): a nationwide study with competing risks analyses". Scand. J. Gastroenterol. 51 (2): 225–35. doi:10.3109/00365521.2015.1067903. PMID 26161590.
  34. ↑ Merion RM (2004). "When is a patient too well and when is a patient too sick for a liver transplant?". Liver Transpl. 10 (10 Suppl 2): S69–73. doi:10.1002/lt.20265. PMID 15382215.
  35. ↑ Abt PL, Desai NM, Crawford MD, Forman LM, Markmann JW, Olthoff KM, Markmann JF (2004). "Survival following liver transplantation from non-heart-beating donors". Ann. Surg. 239 (1): 87–92. doi:10.1097/01.sla.0000103063.82181.2c. PMC 1356197. PMID 14685105.
  36. ↑ Roberts MS, Angus DC, Bryce CL, Valenta Z, Weissfeld L (2004). "Survival after liver transplantation in the United States: a disease-specific analysis of the UNOS database". Liver Transpl. 10 (7): 886–97. doi:10.1002/lt.20137. PMID 15237373.
  37. ↑ Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J (2001). "Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center". Hepatology (Baltimore, Md.). 33 (1): 22–7. doi:10.1053/jhep.2001.20894. PMID 11124816. Retrieved 2012-09-06.
  38. ↑ McCormick PA, Dick R, Burroughs AK (1994). "Review article: the transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension". Aliment. Pharmacol. Ther. 8 (3): 273–82. PMID 7918921.
  39. ↑ Loffroy R, Estivalet L, Cherblanc V, Favelier S, Pottecher P, Hamza S, Minello A, Hillon P, Thouant P, Lefevre PH, Krausé D, Cercueil JP (2013). "Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage". World J. Gastroenterol. 19 (37): 6131–43. doi:10.3748/wjg.v19.i37.6131. PMC 3787342. PMID 24115809.
  40. ↑ 40.0 40.1 40.2 40.3 Boyer TD, Haskal ZJ (2005). "The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension". Hepatology (Baltimore, Md.). 41 (2): 386–400. doi:10.1002/hep.20559. PMID 15660434. Retrieved 2012-09-06.
  41. ↑ 41.0 41.1 41.2 Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP (1993). "Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review". Radiographics : a Review Publication of the Radiological Society of North America, Inc. 13 (6): 1185–210. PMID 8290720. Retrieved 2012-09-06.
  42. ↑ Senanayake SM, Niriella MA, Weerasinghe SK, Kasturiratne A, de Alwis JP, de Silva AP, Dassanayake AS, de Silva HJ (2012). "Survival of patients with alcoholic and cryptogenic cirrhosis without liver transplantation: a single center retrospective study". BMC Res Notes. 5: 663. doi:10.1186/1756-0500-5-663. PMC 3543705. PMID 23198995.
  43. ↑ 43.0 43.1 Colombato L (2007). "The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension". Journal of Clinical Gastroenterology. 41 Suppl 3: S344–51. doi:10.1097/MCG.0b013e318157e500. PMID 17975487. Retrieved 2012-09-06.

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