Cavoportal Hemitransposition in Liver Transplantation

Varma, Chintalapati; Mistry, Bhargav; Glockner, James F.; Solomon, Harvey; Garvin, Paul J.

doi:10.1097/00007890-200109150-00038

Cited by 20 publications

(19 citation statements)

References 9 publications

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“…One of these techniques is porto‐caval (alternatively, cavo‐portal) hemitransposition (PCH), which was first described in 1998. Subsequent reports in adult and pediatric recipients have confirmed the clinical applicability of this surgical technique (1–7). The latest published data amount to a total of 41 patients, 10 of which were of pediatric age (8).…”

Section: Introductionmentioning

confidence: 81%

Ten-Year Experience in Porto-Caval Hemitransposition for Liver Transplantation in the Presence of Portal Vein Thrombosis

Selvaggi

Weppler

Nishida

et al. 2007

American Journal of Transplantation

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Porto-caval hemitransposition (PCH) in liver transplantation allows revascularization of the liver when the porto-mesenteric axis is thrombosed. We, here, review our experience over an 11-year period. A total of 23 patients underwent liver transplantation using PCH. Immunosuppression was based on tacrolimus, with sirolimus used in case of renal insufficiency. Most common diagnoses were hepatitis C, Laennec's, BuddChiari and cryptogenic cirrhosis. Six patients needed splenectomy prior to transplant, 5 during transplant, 1 post-transplant, 11 had no splenectomy. Overall survival was 60% at 1 year and 38% at 3 years, with 10 of 23 patients currently alive and the longest survivor at 9.3 years. Most common cause of death was sepsis/multisystem organ failure, followed by pulmonary embolism. A total of 7/23 patients experienced postoperative gastrointestinal bleeding episodes, 6/23 patients developed thrombosis of the vena cava (median 162 days post-op). Post-operative ascites was noted in almost all patients. Renal dysfunction was commonly seen even after the first month post-transplant. PCH offers a feasible option for liver transplantation in those patients with complex thrombosis of the mesenteric and portal circulation.

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Section: Introductionmentioning

confidence: 81%

Ten-Year Experience in Porto-Caval Hemitransposition for Liver Transplantation in the Presence of Portal Vein Thrombosis

Selvaggi

Weppler

Nishida

et al. 2007

American Journal of Transplantation

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“…On the one hand, the ideal technique must be able to provide an adequate venous inflow to the graft and, on the other hand, allow a sufficient venous drainage to prevent post‐operative persistence of portal hypertension (8). In the case of a cavoportal anastomosis, venous drainage of the portal venous system is primarily based on pre‐existing collaterals between the splanchnic and systemic circulation or on a portovenous surgical shunt, if inserted previously (38). Chronic portal hypertension in patients with liver cirrhosis leads to dilation of the portal, superior mesenteric, splenic and coronary veins and opening of gastroesophageal and splenorenal collaterals.…”

Section: Discussionmentioning

confidence: 99%

Surgical strategies for liver transplantation in the case of portal vein thrombosis – current role of cavoportal hemitransposition and renoportal anastomosis

Paškonis

Jurgaitis

Mehrabi

et al. 2006

Clinical Transplantation

113

123

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Portal vein thrombosis (PVT), a common complication of end stage liver disease, is no longer considered a definite contraindication for liver transplantation (LTx). The clinical decision to perform an LTx in the case of PVT depends on the degree of PVT and the experience of the surgeon. Eversion thromboendovenectomy was suggested by most authors as the surgical technique of choice for PVT grade 1, 2, and 3. If PVT obstructs more extended parts of the porto-mesenteric venous circulation, surgical options would include different types of venous jump graft reconstructions or arterialization of the portal vein. Combined liver and small bowel transplantation is another possible alternative. Cavoportal hemitransposition (CPHT) and renoportal anastomosis (RPA) were recently particularly advocated as creative surgical strategies in case of diffuse PVT. In this work, we focus on CPHT and RPA surgical techniques during LTx, which attempts to secure the portal flow to the liver graft in case of pre-existent diffuse PVT. We provide a review of all reported clinical experience at international clinical centers using these techniques. According to our meta-analysis a total of 15 studies were published on this topic between 1996 and 2005. In summary, a total of 56 orthotopic LTx have been performed in 53 patients (28 men, 25 women) combined with either CPHT or RPA, for the purpose of providing the donor graft with adequate inflow. Mean age was 44 yr including two patients who were infants, with the youngest recipient being two yr old. Main indications for LTx were liver cirrhosis caused by viral hepatitis, alcoholic cirrhosis and cryptogenic cirrhosis. CPHT was performed in 46 cases, and RPA in 10 cases. Thirty-five of 53 patients (66%) had surgery previous to LTx. Of these, 13 patients (37%) [corrected] presented with a history of other previous surgical procedures for decompression of portal hypertension or treatment of associated complications (portocaval shunts, splenectomy, etc). Ascites, renal dysfunction, lower extremity and torso edema and variceal bleeding were dominant post-operative complications after CPHT or RPA noted in 22 cases (41.5%), 18 cases (34%), 17 cases (32%) and 13 cases (24.5%) respectively. Patients' follow-up ranged from two to 48 months. Thirty nine of 53 patients [corrected] (74%) survived [corrected] and 14 patients died (26%) [corrected] during the course of observation. Based on the literature, we conclude that the ideal technique to overcome PVT during LTx is still controversial. Short-term follow-up results of both methods are promising, however, long-term results are unknown at present. Furthermore, clinical follow-up and basic experimental work is required to evaluate the influence of systemic venous inflow to the liver graft with respect to long-term liver function and liver regeneration.

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“…CPH remains an accepted option for patients with extensive portal and superior mesenteric vein thrombosis when no alternative collateral vein is available . In spite of its application in our patient, graft function did not improve requiring urgent re‐OLT to save the patient's life.…”

Section: Discussionmentioning

confidence: 73%

Cavoportal hemitransposition for unrecognized spontaneous mesocaval shunt after liver transplantation: a case report

Chmurowicz¹,

Zasada-Cedro²,

Wójcicki

2013

Transpl Int

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SummarySpontaneous portosystemic shunts can steal the blood away from the portal system. This may result in graft dysfunction or even loss following liver transplantation and can be sorted by shunt occlusion based on intraoperative flow measurements. Herein, we present an alternative technique with cavoportal hemitransposition performed for unrecognized spontaneous mesocaval shunt with 'portal steal' syndrome and primary graft nonfunction diagnosed first day following the transplant. This was chosen as a rescue strategy because an attempt to locate the shunt during relaparotomy was unsuccessful. As there was no improvement, emergency liver retransplantation with preservation of the cavoportal hemitransposition was performed on the fourth day after the primary transplant with good long-term outcome. We conclude that cavoportal hemitransposition during or after liver transplantation can be used to provide an adequate inflow into the donor portal vein if the shunting vessels responsible for the steal cannot be located and dealt with at surgery.

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Cavoportal Hemitransposition in Liver Transplantation

Cited by 20 publications

References 9 publications

Ten-Year Experience in Porto-Caval Hemitransposition for Liver Transplantation in the Presence of Portal Vein Thrombosis

Ten-Year Experience in Porto-Caval Hemitransposition for Liver Transplantation in the Presence of Portal Vein Thrombosis

Surgical strategies for liver transplantation in the case of portal vein thrombosis – current role of cavoportal hemitransposition and renoportal anastomosis

Cavoportal hemitransposition for unrecognized spontaneous mesocaval shunt after liver transplantation: a case report

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