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.