Successful treatment of hepatic veno-occlusive disease in a peripheral blood progenitor cell transplant patient with a transjugular intrahepatic portosystemic stent-shunt (TIPS)

Abstract

Hepatic veno-occlusive disease (VOD) is a common cause of morbidity and mortality after BMT. Although treatment of VOD is primarily supportive, some success has been obtained recently with fibrinolytic therapy. However, for critically ill patients liver transplantation may be the only therapeutic option. Nevertheless, this procedure is associated with high mortality and can only be performed in a minority of cases. The transjugular intrahepatic portosystemic stent-shunt (TIPS) is a non-surgical, side-to-side shunt consisting of an intraparenchymal duct between a main branch of the portal vein and a hepatic vein. In this report we describe a patient who underwent TIPS placement for severe VOD following autologous PBPC transplant. No complications developed and gradual improvement in clinical status and liver function was observed early after this therapy. Nine months after TIPS, the patient is asymptomatic with normal liver function. TIPS provides an interesting alternative to invasive therapies for patients with severe VOD after bone marrow or PBPC transplants.