Danis stent as a bridge to liver transplantation

We want to present to you the case of a 66-year-old female patient from the Czech Republic, without substantial internal comorbidities. In September 2010, she was treated for 3 weeks with amoxicillin for suspected Lyme disease (erythema migrans). She was later diagnosed with advanced liver cirrhosis, which was most likely autoimmune in origin. The acute deterioration was ascribed to “acute-on-chronic” liver failure caused by drug toxicity. Due to the progression of liver dysfunction, the patient was indicated for liver transplantation.

On the third day after enrolment in the waiting list, she presented acute variceal bleeding. Treatment with endoscopic ligation failed and, thus, a Danis, self-expandable covered metallic esophageal stent was inserted. Because of the significant hepatic insufficiency and prolonged encephalopathy, it was not possible to perform TIPS and the patient was left with the Danis stent until liver transplantation.

The third day after orthotopic liver transplantation, and a total of 12 days after the introduction of the stent, the esophageal stent was extracted without complications. Only minimal superficial ulcerations on the mucosa were visible.

More than ten years after the intervention, the patient still shows good liver graft function.

Source: Hepatogastroenterology Department, Transplantation centre, IKEM, Prague