TIPS Creation After Liver Transplantation: Review of Outcomes and Procedural Considerations

• Identify the indications and outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation in liver transplant recipients based on review of the literature.


• Understand transplant liver anatomy relevant for TIPS creation for both whole and split grafts.


• Recognize technical considerations of TIPS creation in liver transplant recipients.

TIPS creation for the management of portal hypertension-related complications in native livers is well established, however the role of TIPS in liver transplant recipients is less clear. Liver transplant recipients may develop recurrent liver disease and sequelae of portal hypertension, such as refractory ascites, variceal hemorrhage and portal vein thrombosis. Some studies suggest that TIPS creation is effective for treating complications of portal hypertension in this patient population, although the available evidence is limited. Although the post-liver transplant anatomy may pose technical challenges, TIPS creation has been shown to be technically feasible and safe in the setting of both whole and split grafts.

Clinical Findings/Procedure Details: This educational exhibit will:

• Describe the role of TIPS in the management of portal hypertension related complications in liver transplant recipients.


• Review the current evidence regarding the technical feasibility, safety, and clinical effectiveness of TIPS after liver transplantation.


• Discuss the altered anatomy of liver transplant recipients with a focus on the types of hepatic venous anastomoses and hepatic vein to portal vein relationships for whole liver and split grafts.


• Highlight procedural approaches, tools, and techniques for TIPS creation in liver transplant recipients with example cases.

TIPS creation can be feasible and effective for treating portal hypertension complications in liver transplant recipients. A comprehensive understanding of the current procedure indications, post-transplant anatomy and technical approach, and clinical outcomes is essential for Interventional Radiologists to appropriately select patients, perform safe TIPS creation, and effectively treat portal hypertensive complications.