Ann Liver Transplant.  2023 May;3(1):17-22. 10.52604/alt.23.0009.

Rescue therapy using transjugular intrahepatic portosystemic shunt for sudden-onset portal vein thrombosis-associated ascites after living donor liver transplantation

• Yang G
• Hwang S
• Ko GY
• Song GW
• Moon DB
• Jung DH
• Ahn CS
• Ha TY
• Park GC

• KMID: 2560917
• DOI: http://doi.org/10.52604/alt.23.0009

Abstract

Sudden-onset portal vein (PV) thrombosis can result in refractory massive ascites. Transjugular intrahepatic portosystemic shunt (TIPS) can be a bridge or rescue therapy for the restoration of portal blood flow and control of ascites. We present one case of a liver transplant recipient who underwent TIPS as a rescue therapy to control PV thrombosis-associated refractory ascites. The patient who had received living donor liver transplantation 15 years before had PV thrombosis, which resulted in sudden-onset massive ascites. TIPS was performed to control refractory ascites. Soon after TIPS, the amount of ascites decreased rapidly, and the patient was discharged at 3 weeks after TIPS. Anticoagulation was maintained to prevent thrombus formation. Liver function was maintained well after TIPS, but the patient suffered from several episodes of hepatic encephalopathy. At 6 months after TIPS, stent flow was well maintained with stable liver function. Retransplantation was planned for the patient. In conclusion, the present case suggests that TIPS can be used as a rescue therapy for refractory ascites in liver transplant recipients with graft failure-associated portal vein thrombosis.

Keyword

Portal vein thrombosis; Portal hypertension; Refractory ascites; Graft failure; Radiologic intervention

Figure

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  Figure 1 Peritransplant computed tomography scans taken before transplantation (A, B) and one year after transplantation (C, D).

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  Figure 2 Computed tomography taken at 14 years after transplantation. (A) Some morphological changes were visible at the right posterior section area. (B–D) Inflow portal vein and outflow right hepatic vein appeared to be patent.

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  Figure 3 Computed tomography taken at 15 years after transplantation. (A) Massive ascites was identified. (B–D) Complete occlusion of the main portal vein by thrombus was found (arrows).

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  Figure 4 Procedures of transjugular intrahepatic portosystemic shunt. (A, B) Superior mesenteric vein venogram showed total thrombotic occlusion of main portal vein with the development of collaterals. (C) A puncture was performed from the right hepatic vein to the right posterior portal vein. (D) Balloon dilation was performed. (E) Stenting was performed using two covered stents. Balloon angioplasty was performed and additional bare metal stent was inserted. (F) Completion superior mesenteric vein venogram showed patent stent flow without thrombus.

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  Figure 5 Computed tomography taken at 4 months after transjugular intrahepatic portosystemic shunt. Stenting was patent at the right hepatic vein (A, B) and at the portal vein (C, D).

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