Transjugular intrahepatic portosystemic shunt creation in children: Initial clinical experience

PURPOSE: To asses an initial clinical experience with the creation of a transjugular intrahepatic portosystemic shunt (TIPS) in children. MATERIALS AND METHODS: Twelve consecutive patients with complications of portal hypertension underwent TIPS creation at our institution between July 1993 and September 1996. There were six boys and six girls aged 2 years 5 months to 16 years 10 months (median, 9 years 2 months) who weighed 13.9-80.9 kg (median, 27.65 kg). A standard radiographic technique was used. RESULTS: Thirteen procedures were performed to achieve 12 successful TIPS creations. One child with a reduced-size liver transplant had to undergo two procedures for a successful TIPS creation. No major procedural complications or morbidity occurred. In 10 children, TIPS patency was documented by means of pathologic inspection at orthotopic liver transplantation (median shunt duration, 53 days). Shunt stenosis developed in one child at 186 days but was treated successfully. Two children had functional shunts at 301 and 357 days, respectively. No episodes of repeat variceal hemorrhage were noted. One child developed postprocedural encephalopathy, which responded to medical therapy. CONCLUSION: This initial critical experience suggests that TIPS creation is technically feasible and is as safe in children as in adults. TIPS creation can aid in the management of portal hypertension in children, especially in those needing temporary relief before liver transplantation.