David Eugenio Hinojosa-Gonzalez1, Eduardo Tellez-Garcia1, Gustavo Salgado-Garza1, Andres Roblesgil-Medrano1, Luis Carlos Bueno-Gutierrez1, Sergio Uriel Villegas-De Leon1, Maria Alejandra Espadas-Conde1, Francisco Eugenio Herrera-Carrillo1, Eduardo Flores-Villalba1,2

1School of Medicine and Health Sciences, Monterrey Institue of Technology, Monterrey, Mexico
2Department of Advanced Manufacturing, School of Engineering and Sciences, Monterrey Institue of Technology, Monterrey, Mexico


Objective: Orthotopic liver transplantation (OLT) remains the definitive treatment for patients afflicted with end-stage liver disease (ESLD). Transjugular intrahepatic portosystemic shunts (TIPS) have been adapted as a bridge to transplantation, allowing partial normalization of portal pressure and associated symptom improvement. Conflicting evidence exists on TIPS’ impact on operative procedures. This study aimed to analyze available evidence on patients who underwent OLT with prior TIPS compared to OLT alone with the intent to determine TIPS’ impact on surgical outcomes.

Material and Methods: Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing TIPS + OLT versus OLT alone in patients with ESLD. Data were analyzed using Review Manager 5.3.

Results: Thirteen studies were included. Operative time, packed red blood cells transfusions, intensive care unit admission, length of stay, dialysis, serum creatinine levels, ascites, vascular complications, bleeding revisions, reintervention, and other complications rates were similar between both groups. Fresh frozen plasma transfusion -2.88 units (-5.42, -0.35; p= 0.03), was lower in the TIPS + OLT group.

Conclusion: Our study found TIPS can be safely employed without having detrimental impacts on OLT outcomes, furthermore, these findings also suggest TIPS does not increase bleeding or complications.

Keywords: Liver transplant, transjugular intrahepatic portosystemic shunts, shunt, liver, model for end-stage liver disease

Cite this article as: Gonzalez DEH, Garcia ET, Garza GS, Medrano AR, Gutierrez LCB, De Leon SUV, et al. Intraoperative and postoperative impact of pretransplantation transjugular intrahepatic portosystemic shunts in orthotopic liver transplantations: A systematic review and meta-analysis. Turk J Surg 2022; 38 (2): 121-133.


Ethics Committee Approval

Not relevant.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - E.F.V., F.E.H.C., D.E.H.G., G.S.G.; Design - D.E.H.G., G.S.G.; Supervision - E.F.V., A.E.C., S.U.V.D.L.; Data Collection and/ or Processing - G.S.G., F.E.H.C., S.U.V.D.L., A.R.M., L.C.B.G., A.E.C., E.T.G.; Analysis and/or Interpretation - E.T.G., A.E.C., L.C.B.G., D.E.H.G.; Literature Search - F.E.H.C., S.U.V.D.L., A.R.M.; Writing Manuscript - E.T.G., G.S.G.; Critical Reviews - D.E.H.G., L.C.B.G.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.