{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T13:57:14Z","timestamp":1764251834834,"version":"3.41.2"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T00:00:00Z","timestamp":1686182400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The management of complex, intra\u2010 and extrahepatic portal vein thrombosis (PVT) after liver transplantation (LT) is challenging. Although most of the patients remain asymptomatic or oligosymptomatic in the chronic setting, some of them may develop severe portal hypertension and related complications, notably gastrointestinal (GI) bleeding. In the emergency scenario, clinical and endoscopic treatments as well as intensive support constitute the bases of conservative management, while more definitive treatment options such as surgical shunting and retransplantation are related to high morbidity rates. Transjugular intrahepatic portosystemic shunt (TIPS) was largely considered of limited role due to technical difficulties arising from extensive PVT. Recently, however, new minimally invasive image\u2010guided techniques emerged, allowing portal vein recanalization and TIPS creation simultaneously (TIPS\u2010PVR), even in complex PVT pretransplant patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Herein, we describe a novel indication for TIPS\u2010PVR in a post\u2010LT adolescent presenting with life\u2010threatening, refractory GI bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The patient presented with complete resolution of the hemorrhagic condition after the procedure, with no deterioration of hepatic function or hepatic encephalopathy. Follow\u2010up Doppler ultrasound after TIPS\u2010PVR showed normal hepatopetal venous flow within the stents, and no evidence of complications, including intraperitoneal or peri splenic bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This report describes the feasibility of TIPS\u2010PVR in the post\u2010LT scenario complicated by extensive PVT. In this case, a complete resolution of the life\u2010threatening GI bleeding was achieved, with no major complications. Other patients with complex chronic PVT might benefit from the use of the described technique, but further studies are required to determine the correct timing and indications of the procedure, eventually before the occurrence of life\u2010threatening complications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14555","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T05:27:10Z","timestamp":1686288430000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Life\u2010threatening variceal bleeding after liver transplantation and extensive portal vein thrombosis: Desperate times call for desperate measures"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8924-7680","authenticated-orcid":false,"given":"Andr\u00e9Moreira","family":"de Assis","sequence":"first","affiliation":[{"name":"Interventional Radiology Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o 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