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Vol. 16. Issue 6.
Pages 979-980 (November - December 2017)
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Vol. 16. Issue 6.
Pages 979-980 (November - December 2017)
DOI: 10.5604/01.3001.0010.5292
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Paulina Chinchilla-López, Oscar Ramírez-Pérez, Vania Cruz-Ramón, Nahum Méndez-Sánchez
Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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We appreciate your interest and comments of our work published in Annals of Hepatology. It is well known that Transjugular Intrahepatic Portal Shunt (TIPS) is a good alternative for management of complications of portal hypertension. However, nowadays the management of intrahepatic portal thrombosis is a controversial subject due to the lack of evidence and the challenge it represents. We believe that our case was handled in a correct manner supported by global recommendations and guidelines.1,2 According to Rössle, et al.,3 TIPS-based therapy was sustained in our patient due to the following reasons: The failure of anticoagulant therapy and the lack of response to drugs of its refractory ascites.4 Moreover, this therapy could be a protective factor for the refractory bleeding.5,6 Furthermore, our patient was candidate for liver transplantation and it is well known that TIPS placement has demonstrated to be useful for decreasing the complications of patients awaiting liver transplant. In these cases, TIPS procedure has been used as a bridging therapy to allow them to remain on the transplant list longer and reduce patient dropout.7,8 Perhaps subsequent measurements of portal venous pressure had needed to verify the portal vein pressure of our patient. Finally, we believe that the management of our patient is supported by the current recommendations of AASLD and EASL for the use of TIPS.2,4

Conflicts of Interest

The authors disclose no conflicts.

References
[1.]
European Association for the Study of the Liver.
EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis.
J Hepatol, 3 (2010), pp. 397-417
[2.]
Boyer T, Haskal Z, AASLD Practice Guidelines: The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension.
Hepatology, 1 (2010), pp. 1-16
[3.]
Rössle M.
TIPS: 25 years later.
J Hepatol, 59 (2013), pp. 1081-1093
[4.]
Tsochatzis EA, Gerbes AL.
Diagnosis and treatment of as-cites.
J Hepatol, 67 (2017), pp. 184-185
[5.]
Wong F.
The use of TIPS in chronic liver disease.
Annals of Hepatology, 1 (2006), pp. 5-15
[6.]
García-Tsao G, Abraldes JG, Berzigotti A, Bosch J.
Portal Hypertensive Bleeding in Cirrhosis: Risk Stratification, Diagnosis and Management: 2016 Practice Guidance by the American Association for the Study of Liver Diseases.
Hepatology, 1 (2017), pp. 310-335
[7.]
Moreno A, Meneu JC, Moreno E, Fraile M, Garcia I, Loinaz C, Abradelo M, et al.
Liver transplantation and transjugular int-rahepatic portosystemic shunt.
Transplant Proc, 35 (2003), pp. 1869-1870
[8.]
Gonzales P, Dhanasekaran R, West J, Subramanian R, Parekh S, Spivey JR, Preeti Reshamwala, et al.
Influence of transjugular intrahepatic portosystemic shunt in patients awaiting orthotopic liver transplant on post-transplant outcome.
Gastrointestinal Intervention, 1 (2012), pp. 69-73
Copyright © 2017. Fundación Clínica Médica Sur, A.C.
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