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Goran B Klintmalm - One of the best experts on this subject based on the ideXlab platform.

  • a comparison of treatment with transjugular intrahepatic portosystemic shunt or distal splenorenal shunt in the management of variceal bleeding prior to liver transplantation
    Transplantation, 1995
    Co-Authors: Marwan S Abouljoud, Marlon F Levy, Chet R Rees, Norman G Diamond, David C Mulligan, Robert M Goldstein, B S Husberg, Thomas A Gonwa, Goran B Klintmalm
    Abstract:

    : Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT). Endoscopic sclerotherapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS) has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS). In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients) or DSRS (17 patients) for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P = 0.014) but transfusion requirements were similar. Intraoperative Portal Vein Blood flow measurements averaged 2132 +/- 725 ml/min in the TIPS group compared with 1120 +/- 351 ml/min in the DSRS group (P < 0.001). Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P = 0.1). We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intraoperative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified.

Zhenping He - One of the best experts on this subject based on the ideXlab platform.

  • radiofrequency ablation for hypersplenism in patients with liver cirrhosis a pilot study
    Journal of Gastrointestinal Surgery, 2005
    Co-Authors: Jiahong Dong, Zhenping He, Xuequan Huang, Liang Qiao
    Abstract:

    Radiofrequency ablation is a relatively new technique used for local ablation of unresectable tumors. We investigated the feasibility and eficacy of radiofrequency ablation for hypersplenism and its effect on liver function in patients with liver cirrhosis and Portal hypertension. Nine consecutive patients with hypersplenism due to cirrhotic Portal hypertension underwent radiofrequency ablation in enlarged spleens. The ablation was performed either intraoperatively or percutaneously. Patients are followed up for over 12 months. After treatment, between 20% and 43% of spleen volume was ablated, and spleen volume increased by 4%–10.2%. White Blood cell count, platelet count, liver function, and hepatic artery Blood flow showed significant improvement after 1-year follow-up. Splenic Vein and Portal Vein Blood flow were significantly reduced. Only minor complications including hydrothorax (three of nine patients) and mild abdominal pain (four of nine patients) were observed. No mortality or other morbidity occurred. Radiofrequency ablation is a safe, effective, and minimally invasive approach for the management of splenomegaly and hypersplenism in patients with liver cirrhosis and Portal hypertension. Increased hepatic artery Blood flow may be responsible for sustained improvement of liver condition. Radiofrequency ablation may be used as a bridging therapy for cirrhotic patients waiting for liver transplantation.

Jiahong Dong - One of the best experts on this subject based on the ideXlab platform.

  • left renal Vein ligation for large splenorenal shunt during liver transplantation
    Anz Journal of Surgery, 2017
    Co-Authors: Rui Tang, Modan Li, Shan Shen, Xin Huang, Wenping Zhao, Jiahong Dong
    Abstract:

    : Adequate hepatopetal Portal Vein Blood flow is obligatory to ensure proper liver function after liver transplantation. Large collateral Veins as shunts impair Portal Vein flow and even cause hepatofugal Blood flow and Portal steal syndrome. In particular, splenorenal shunts in liver transplant recipients can lead to allograft dysfunction and possible allograft loss or hepatic encephalopathy. Restoration of Portal flow through left renal Vein ligation (LRVL) is a treatment option, which is much easier compared to splenectomy, renoPortal anastomosis and shunt closure, but bears the risk of moderate and temporary impairment of renal function. In addition, a patent Portal Vein is mandatory for LRVL. However, although LRVL has been reported to be an effective, safe and easy method to control portacaval shunts and increase hepatopetal flow in some studies, indications and safety are still not clear. In this review, we summarize existing studies on LRVL during liver transplantation.

  • radiofrequency ablation for hypersplenism in patients with liver cirrhosis a pilot study
    Journal of Gastrointestinal Surgery, 2005
    Co-Authors: Jiahong Dong, Zhenping He, Xuequan Huang, Liang Qiao
    Abstract:

    Radiofrequency ablation is a relatively new technique used for local ablation of unresectable tumors. We investigated the feasibility and eficacy of radiofrequency ablation for hypersplenism and its effect on liver function in patients with liver cirrhosis and Portal hypertension. Nine consecutive patients with hypersplenism due to cirrhotic Portal hypertension underwent radiofrequency ablation in enlarged spleens. The ablation was performed either intraoperatively or percutaneously. Patients are followed up for over 12 months. After treatment, between 20% and 43% of spleen volume was ablated, and spleen volume increased by 4%–10.2%. White Blood cell count, platelet count, liver function, and hepatic artery Blood flow showed significant improvement after 1-year follow-up. Splenic Vein and Portal Vein Blood flow were significantly reduced. Only minor complications including hydrothorax (three of nine patients) and mild abdominal pain (four of nine patients) were observed. No mortality or other morbidity occurred. Radiofrequency ablation is a safe, effective, and minimally invasive approach for the management of splenomegaly and hypersplenism in patients with liver cirrhosis and Portal hypertension. Increased hepatic artery Blood flow may be responsible for sustained improvement of liver condition. Radiofrequency ablation may be used as a bridging therapy for cirrhotic patients waiting for liver transplantation.

Liang Qiao - One of the best experts on this subject based on the ideXlab platform.

  • radiofrequency ablation for hypersplenism in patients with liver cirrhosis a pilot study
    Journal of Gastrointestinal Surgery, 2005
    Co-Authors: Jiahong Dong, Zhenping He, Xuequan Huang, Liang Qiao
    Abstract:

    Radiofrequency ablation is a relatively new technique used for local ablation of unresectable tumors. We investigated the feasibility and eficacy of radiofrequency ablation for hypersplenism and its effect on liver function in patients with liver cirrhosis and Portal hypertension. Nine consecutive patients with hypersplenism due to cirrhotic Portal hypertension underwent radiofrequency ablation in enlarged spleens. The ablation was performed either intraoperatively or percutaneously. Patients are followed up for over 12 months. After treatment, between 20% and 43% of spleen volume was ablated, and spleen volume increased by 4%–10.2%. White Blood cell count, platelet count, liver function, and hepatic artery Blood flow showed significant improvement after 1-year follow-up. Splenic Vein and Portal Vein Blood flow were significantly reduced. Only minor complications including hydrothorax (three of nine patients) and mild abdominal pain (four of nine patients) were observed. No mortality or other morbidity occurred. Radiofrequency ablation is a safe, effective, and minimally invasive approach for the management of splenomegaly and hypersplenism in patients with liver cirrhosis and Portal hypertension. Increased hepatic artery Blood flow may be responsible for sustained improvement of liver condition. Radiofrequency ablation may be used as a bridging therapy for cirrhotic patients waiting for liver transplantation.

Marwan S Abouljoud - One of the best experts on this subject based on the ideXlab platform.

  • a comparison of treatment with transjugular intrahepatic portosystemic shunt or distal splenorenal shunt in the management of variceal bleeding prior to liver transplantation
    Transplantation, 1995
    Co-Authors: Marwan S Abouljoud, Marlon F Levy, Chet R Rees, Norman G Diamond, David C Mulligan, Robert M Goldstein, B S Husberg, Thomas A Gonwa, Goran B Klintmalm
    Abstract:

    : Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT). Endoscopic sclerotherapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS) has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS). In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients) or DSRS (17 patients) for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P = 0.014) but transfusion requirements were similar. Intraoperative Portal Vein Blood flow measurements averaged 2132 +/- 725 ml/min in the TIPS group compared with 1120 +/- 351 ml/min in the DSRS group (P < 0.001). Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P = 0.1). We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intraoperative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified.