Feasibility and outcomes of transjugular intrahepatic portosystemic shunts in infants

Abstract

Background: Experience with transjugular intrahepatic portosystemic shunts (TIPS) in the pediatric population, especially in infants, is limited.

Objective: To evaluate the feasibility, efficacy and safety of TIPS placement in infants.

Materials and methods: This retrospective non-comparative observational cohort study analyzed all pediatric patients < 12 months of age treated with TIPS while waiting for liver transplant between October 2018 and April 2021. The sample consisted of 10 infants with chronic liver disease. All had refractory ascites and decreased portal vein size. Their mean age ± standard deviation was 5 ± 1 months and their mean weight was 5.4 ± 1.0 kg. We calculated the pediatric end-stage liver disease score and portosystemic gradients before and after TIPS placement. We used ultrasound to check for complications and to assess the presence of ascites. We used paired-sample t-test for the mean comparison of paired variables.

Results: Ten TIPS procedures were performed that were technically and hemodynamically successful except for one, in which an extrahepatic portal puncture required surgical repair. Ascites resolved in three infants and was reduced in six. The portal vein size remained stable after TIPS placement. Four infants had early stent thrombosis and two had late stent thrombosis treated with angioplasty or covered stents.

Conclusion: TIPS placement in infants is a feasible, safe and effective procedure.

Keywords: Biliary atresia; Infants; Interventional radiology; Liver; Portal hypertension; Transjugular intrahepatic portosystemic shunt; Transplant.