From the first one hundred consecutive patients treated by transjugular intrahepatic portosystemic shunt (TIPS), 12 subsequently underwent liver transplantation (a mean of 103 +/- 109 days after TIPS). Fourteen TIPS were created in 12 patients, with advanced cirrhosis (Child B = 5, C = 7) and portal hypertension. Seven patients presented either active variceal hemorrhage or refractory variceal bleeding, and 5 cases of refractory ascites. The shunt could be performed in all cases. Two patients experienced rebleeding (one after a shunt obstruction) and were successfully treated by insertion of a second TIPS. A histological study was performed in 10 cases. The shunt was patent in all cases (except in one case previously described), and the endoluminal surface was covered by a connective tissue layer and a new endothelium. We therefore conclude that this method is a safe and effective therapy for complications of portal hypertension, in patients referred for liver transplantation.