Document Detail


Transjugular intrahepatic portosystemic shunt for the management of severe venoocclusive disease following bone marrow transplantation.
MedLine Citation:
PMID:  8781329     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hepatic venoocclusive disease (VOD) is a common, life-threatening complication of bone marrow transplantation (BMT). Portal hypertension is usually present and accounts for many of the clinical manifestations of this syndrome. We describe the results of transjugular intrahepatic portosystemic shunt (TIPS) for the management of VOD after BMT TIPS was performed in six patients with histologically confirmed VOD who had progressive jaundice and ascites. Portal hypertension was improved by TIPS in all patients (mean portal pressure gradient before TIPS, 20.2 +/- 4.6 vs. 6.7 +/- 1.9 mm Hg post-TIPS, P < .004). Three patients who underwent TIPS late in the course of VOD did not demonstrate any clinical improvement after TIPS and expired within 2 weeks of the procedure. The remaining three patients had less advanced disease and demonstrated decreases in serum bilirubin, improvement in coagulopathy, and decreased ascites after TIPS. Two patients subsequently expired, one with persistent histological changes of VOD. The lone survivor continues to do well with resolution of ascites, jaundice, and coagulopathy as of her last outpatient visit. TIPS was an effective method for portal decompression in patients with VOD after BMT, and was associated with clinical improvement in some patients. However, these effects may be transient and may not improve overall survival.
Authors:
M W Fried; D G Connaghan; S Sharma; L G Martin; S Devine; K Holland; A Zuckerman; S Kaufman; J Wingard; T D Boyer
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Hepatology (Baltimore, Md.)     Volume:  24     ISSN:  0270-9139     ISO Abbreviation:  Hepatology     Publication Date:  1996 Sep 
Date Detail:
Created Date:  1996-12-04     Completed Date:  1996-12-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8302946     Medline TA:  Hepatology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  588-91     Citation Subset:  IM    
Affiliation:
Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Bone Marrow Transplantation*
Female
Hepatic Veno-Occlusive Disease / etiology*,  surgery*
Humans
Jaundice / etiology
Jugular Veins
Liver / pathology
Male
Middle Aged
Necrosis
Portasystemic Shunt, Surgical* / methods
Postoperative Complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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