Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post Transplant Complications

Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation

Bone Marrow Transplantation volume 25, pages 987–992 (2000)Cite this article

Abstract

Severe veno-occlusive disease (VOD) of the liver is a leading cause of mortality after bone marrow transplantation (BMT). Vascular and parenchymal injuries account for acute portal hypertension and liver failure is frequently present. We describe the results of transjugular intrahepatic portosystemic shunt (TIPS) for the management of VOD after BMT. TIPS was performed in 10 patients with histologically proven severe VOD. Portal hypertension was controlled by TIPS in all patients (mean hepatic venous pressure gradient before, 20 ± 11 vs 6 ± 5 mm Hg after TIPS, P < 0.01) without technical complications. Five patients with rapidly worsening VOD died within 10 days of tips without any improvement. The five remaining patients with less advanced disease showed improvement in various clinical and biological parameters. Four patients subsequently died. The lone survivor continues to do well with resolution of VOD 6 months after tips. Tips can be performed safely and controls portal hypertension in VOD after BMT. Arguments from the present series and from eight previously reported cases favour earlier application of tips to obtain improved overall survival. Bone Marrow Transplantation (2000) 25, 987–992.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Shulman HM, Hinterberger W . A review of the hepatic venoclusive disease: liver toxicity syndrome after bone marrow transplantation Bone Marrow Transplant 1992 10: 197–214

    CAS  PubMed  Google Scholar 

  2. Jones RJ, Lee KSK, Beschorner WE et al. Venoocclusive disease of the liver following bone marrow transplantation Transplantation 1987 44: 778–783

    Article  CAS  Google Scholar 

  3. DeLeve LD, McCuskey RS, Wang X et al. Characterization of a reproducible rat model of hepatic veno-occlusive disease Hepatology 1999 29: 1779–1791

    Article  CAS  Google Scholar 

  4. Shulman HM, Fisher LB, Schoch HG et al. Venoocclusive disease of the liver after marrow transplantation: histological correlates of clinical signs and symptoms Hepatology 1994 19: 1171–1180

    Article  CAS  Google Scholar 

  5. Bearman SI, Anderson GL, Mori M et al. Venoocclusive disease of the liver: development of a model for predicting fatal outcome after marrow transplantation J Clin Oncol 1993 11: 1729–1736

    Article  CAS  Google Scholar 

  6. McDonald GB, Hinds MS, Fisher LD et al. Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients Ann Intern Med 1993 118: 255–267

    Article  CAS  Google Scholar 

  7. Carreras E, Granena A, Navasa M et al. Transjugular liver biopsy in BMT Bone Marrow Transplant 1993 11: 21–26

    CAS  PubMed  Google Scholar 

  8. Shulman HM, McDonald GB . Transvenous liver biopsy (TVLB) and pressure measurements in bone marrow transplant (BMT) recipients Hepatology 1992 16: 148 (Abstr.)

    Google Scholar 

  9. Azoulay D, Castaing D, Bismuth H . Transjugular intrahepatic porto-systemic shunt: technique and pitfalls. In: Steichen FM, Welter R (eds). New Techniques in Surgery Quality Medical Publishing: St Louis 1994

    Google Scholar 

  10. Azoulay D, Castaing D, Dennison A et al. Transjugular intrahepatic portosystemic shunt worsens the hyperdynamic circulatory state of the cirrhotic patient: preliminary report of a prospective study Hepatology 1994 19: 129–132

    Article  CAS  Google Scholar 

  11. Levy V, Azoulay D, Rio B et al. Successful treatment of severe hepatic veno-occlusive disease after allogeneic bone marrow transplantation by transjugular intrahepatic portosystemic stent-shunt (TIPS) Bone Marrow Transplant 1996 18: 443–445

    CAS  PubMed  Google Scholar 

  12. Henderson JM, Warren WD, Millikan WJ et al. Surgical options, hematologic evaluation, and pathologic changes in Budd-Chiari syndrome Am J Surg 1990 159: 41–48

    Article  CAS  Google Scholar 

  13. Bismuth H, Sherlock D . Portasystemic shunting versus liver transplantation for the Budd–Chiari syndrome Ann Surg 1991 214: 581–589

    Article  CAS  Google Scholar 

  14. Langnas AN, Sorrell MF . The Budd–Chiari syndrome: a therapeutic Gordian knot? Semin Liver Dis 1993 13: 352–359

    Article  CAS  Google Scholar 

  15. Murray JA, LaBrecque DR, Gingrich RD et al. Successful treatment of hepatic venocclusive disease in a bone marrow transplant patient with a side-to-side portacaval shunt Gastroenterology 1987 92: 1073–1077

    Article  CAS  Google Scholar 

  16. Jacobson BK, Kalayoglu M . Effective early treatment of hepatic venocclusive disease with central splenorenal shunt in an infant J Pediatr Surg 1992 27: 531–533

    Article  CAS  Google Scholar 

  17. De la Rubia J, Carral A, Montes H et al. Successful treatment of hepatic veno-occlusive disease in a peripheral blood progenitor cell transplant patient with a transjugular intrahepatic portosystemic stent-shunt (TIPS) Haematologica 1996 81: 536–539

    CAS  PubMed  Google Scholar 

  18. Smith FO, Johnson MS, Scherer LR et al. Transjugular intrahepatic portosystemic shunting (TIPS) for treatment of severe hepatic veno-occlusive disease Bone Marrow Transplant 1996 18: 643–646

    CAS  PubMed  Google Scholar 

  19. Fried MW, Connaghan DG, Martin LG et al. Transjugular intrahepatic portosystemic shunt for the management of severe venoocclusive disease following bone marrow transplantation Hepatology 1996 24: 588–591

    Article  CAS  Google Scholar 

  20. Rubenfeld GD, Crawford SW . Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines Ann Intern Med 1996 125: 625–633

    Article  CAS  Google Scholar 

  21. Richardson PG, Elias AD, Krishnan A et al. Treatment of severe veno-occlusive disease with defibrotide: compassionate use results in response without significant toxicity in a high-risk population Blood 1998 92: 737–744

    CAS  PubMed  Google Scholar 

  22. Nimer SD, Milewicz AL, Champlin RE, Busuttil RW . Successful treatment of hepatic venoocclusive disease in a bone marrow transplant patient with orthotopic liver transplantation Transplantation 1990 49: 819–821

    Article  CAS  Google Scholar 

  23. Rapoport AP, Doyle HR, Starzl T et al. Orthotopic liver transplantation for life-threatening veno-occlusive disease of the liver after allogenic bone marrow transplant Bone Marrow Transplant 1991 8: 421–424

    CAS  PubMed  Google Scholar 

  24. Dowlati A, Honore P, Damas P et al. Hepatic rejection after orthotopic liver transplantation for hepatic veno-occlusive disease of graft-versus-host disease following bone marrow transplantation Transplantation 1995 60: 106–108

    Article  CAS  Google Scholar 

  25. Hägglund H, Ringdén O, Ericzon BG et al. Treatment of hepatic venoocclusive disease with recombinant human tissue plasminogen activator or orthotopic liver transplantation after allogenic bone marrow transplantation Transplantation 1996 62: 1076–1080

    Article  Google Scholar 

  26. Rosen HR, Martin P, Schiller GJ et al. Orthotopic liver transplantation for bone-marrow transplant-associated veno-occlusive disease of the liver Liver Transplant Surg 1996 2: 225–232

    Article  CAS  Google Scholar 

  27. Bunin N, Leahey A, Dunn S . Related donor liver transplant for veno-occlusive disease following T-depleted unrelated donor bone marrow transplantation Transplantation 1996 61: 664–666

    Article  CAS  Google Scholar 

  28. Norris S, Crosbie O, McEntee G et al. Orthotopic liver transplantation for veno-occlusive disease complicating autologous bone marrow transplantation Transplantation 1997 63: 1521–1524

    Article  CAS  Google Scholar 

  29. Castells A, Salmeron JM, Navasa M et al. Liver transplantation for acute liver failure: analysis of applicability Gastroenterology 1993 105: 532–538

    Article  CAS  Google Scholar 

  30. Ishitani M, Wilkowski M, Stevenson W, Pruett T . Outcome of patients requiring hemodialysis after liver transplantation Transplant Proc 1993 25: 1762–1763

    CAS  PubMed  Google Scholar 

  31. Kuo PC, Johnson LB, Hastings G et al. Fulminant hepatic failure from the Budd–Chiari syndrome. A bridge to transplantation with transjugular intrahepatic portosystemic shunt Transplantation 1996 62: 294–296

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the Bone Marrow Transplant Centers from Saint Louis Hospital (Pr Gluckman, Paris), Hotel Dieu Hospital (Pr Zittoun, Paris), Henri Mondor Hospital (Pr Vernant, Créteil), and Institut Gustave Roussy (Dr Vincent, Dr Hartmann, Villejuif) for sending their patients to us.

Author information

Authors and Affiliations

  1. Hepatobiliary Surgery and Liver Transplantation Center, Villejuif, France

    D Azoulay, D Castaing, GM Hargreaves & H Bismuth

  2. Biochemistry Unit, Paul Brousse Hospital, Villejuif, France

    A Lemoine

Authors
  1. D Azoulay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D Castaing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Lemoine
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. GM Hargreaves
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H Bismuth
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Azoulay, D., Castaing, D., Lemoine, A. et al. Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation. Bone Marrow Transplant 25, 987–992 (2000). https://doi.org/10.1038/sj.bmt.1702386

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1702386

Keywords

This article is cited by

Search

Advanced search

Quick links