Management of spontaneous portosystemic shunts at the time of liver transplantation: treatment or observation? Results of a systematic review

Cusumano, Caterina; Gussago, Stefano; Guerra, Martina; Paul, Chloé; Faitot, François; Bachellier, Philippe; Addeo, Pietro

doi:10.1007/s12072-022-10377-w

Cited by 4 publications

(1 citation statement)

References 27 publications

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“…118,177 SPSS are present in about 20%–35% of transplant candidates, with a recent review on the intraoperative management of SPSS concluding that there was heterogenous management of SPSS during LT, with very little consensus. 178,179 The pathophysiology of the development of SFSS is postulated to be related to the increased portal flow and associated shear stress it causes on a small graft. Consequently, it may seem counterintuitive to ligate the SPSS in SFSG because it may worsen the hyperdynamic circulation.…”

Section: Pimmentioning

confidence: 99%

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

Hakeem,

Mathew,

Aunés

et al. 2023

Transplantation

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Small-for-size syndrome (SFSS) is a well-recognized complication following liver transplantation (LT), with up to 20% developing this following living donor LT (LDLT). Preventing SFSS involves consideration of factors before the surgical procedure, including donor and recipient selection, and factors during the surgical procedure, including adequate outflow reconstruction, graft portal inflow modulation, and management of portosystemic shunts. International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplant Society of India Consensus Conference was convened in January 2023 to develop recommendations for the prediction and management of SFSS in LDLT. The format of the conference was based on the Grading of Recommendations, Assessment, Development, and Evaluation system. International experts in this field were allocated to 4 working groups (diagnosis, prevention, anesthesia, and critical care considerations, and management of established SFSS). The working groups prepared evidence-based recommendations to answer-specific questions considering the currently available literature. The working group members, independent panel, and conference attendees served as jury to edit and confirm the final recommendations presented at the end of the conference by each working group separately. This report presents the final statements and evidence-based recommendations provided by working group 2 that can be implemented to prevent SFSS in LDLT patients.

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Section: Pimmentioning

confidence: 99%

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

Hakeem,

Mathew,

Aunés

et al. 2023

Transplantation

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Budesonide in Liver Immunology: A Therapeutic Opportunity in Liver Transplantation

Liu,

Bonwick,

Sumithran

et al. 2024

Curr Transpl Rep

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Purpose of Review A major remaining challenge in liver transplantation is achieving the balance between adequate immunosuppression to prevent allograft rejection and minimising immunosuppression-related side effects. Systemic corticosteroids contribute to the development of multi-system adverse effects that increase recipient morbidity and mortality. Oral budesonide undergoes significant first-pass hepatic metabolism, thereby minimising systemic availability, but maintains a similar immunosuppressive impact on the liver and gastrointestinal tract as systemic corticosteroids. This review aims to explore the rationale for oral budesonide as an alternative immunosuppressant to conventional corticosteroids following liver transplantation. Recent findings Despite increasing evidence of efficacy and safety in other gastrointestinal conditions, research on the role of budesonide as an alternative immunosuppressant to conventional corticosteroids in the liver transplant setting remains scarce. However, existing literature suggests efficacy in the treatment and prevention of acute rejection after liver transplantation, with minimal toxicity. Summary The unique pharmacokinetic profile of oral budesonide may address the unmet need for a medical therapy that has efficacy but with a better safety profile compared to conventional corticosteroids in the liver transplant setting.

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Small for Size Syndrome in Living Donor Liver Transplantation- Prevention and Management

Reddy,

Gopal

2025

Journal of Clinical and Experimental Hepatology

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Management of spontaneous portosystemic shunts at the time of liver transplantation: treatment or observation? Results of a systematic review

Cited by 4 publications

References 27 publications

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

Budesonide in Liver Immunology: A Therapeutic Opportunity in Liver Transplantation

Small for Size Syndrome in Living Donor Liver Transplantation- Prevention and Management

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