https://www.ncbi.nlm.nih.gov/pubmed/31880663 Portal Hypertension

J Pediatr Gastroenterol Nutr. 2019 Dec 24. doi: 10.1097/MPG.0000000000002597. [Epub ahead of print]
Long-term Outcome of Transjugular Intrahepatic Portosystemic Shunt in children with Portal Hypertension.

Abstract

OBJECTIVES AND STUDY:
A proportion of children with chronic liver disease have severe portal hypertension (PH) and a preserved synthetic and biliary function. In our institution these children have been managed with Transjugular Intrahepatic Porto-systemic Shunts (TIPS). We aimed to evaluate the long-term patency of TIPS placed in paediatric patients with PH.

METHODS:
retrospective study of children who underwent TIPS in the last 15 years. We compared patients with cirrhotic PH (CPH) to those with non-cirrhotic (NCPH), and all with an historical cohort of children who underwent a surgical porto-systemic shunt (SPSS). Kaplan-Meier analysis measured long-term shunt patency.

RESULTS:
29 patients were recorded [CPH = 11, NCPH = 18, mean age 10.3 years (±4.3), mean weight 36.7 Kg (±20.1), mean Pediatric End-Stage Liver disease score 4.1 (±7.1)]; in 5 TIPS was placed after split liver transplantation. Indication for TIPS was variceal bleeding in 18, refractory ascites in 11. Primary patency rates at 6 months and at 1, 2, 4 years were 91%, 83%, 60% and 46% respectively. At last follow up [mean of 2.8 years (±2.4, range 0.1-8.1 years)] secondary patency (after radiological revision) was 100%. The patency rate of the historical cohort of patients who underwent a SPSS was 26/31 (82%) at a median follow up of 12.5 years (1.6-25.8).

CONCLUSION:
TIPS appears to have a high mid-term patency rate, especially if monitored and revised. Its high clinical success rate, along with a minimally invasive approach, suggests that in this setting TIPS should not be regarded only as a bridge to liver transplantation.