Portocaval hemitransposition in pediatric liver transplant recipients: A single-center experience

Lipshutz, Gerald S.; Patel, Shivani; Hiatt, Jonathan R.; Yersiz, Hassan; Farmer, Douglas G.; McDiarmid, Sue V.; Ghobrial, Rafik M.; Busuttil, Ronald W.

doi:10.1002/lt.20770

Cited by 13 publications

(13 citation statements)

References 43 publications

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“…Malnourished were diagnosed when BMI was (<18.5 kg/m²) and normal when BMI was (18.5-25 kg/m²), duration of diabetes [2][3][4][5][6][7][8][9][10][11][12][13][14] year, treatment included type and amount of insulin in units (morning and night dose) then the mean of insulin units was taken. The diagnosis of pediatric NAFLD was made by routine noninvasive evaluation: [38].…”

Section: Patient and Methodsmentioning

confidence: 99%

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Fatty Liver Disease in Children and Adolescents with Type 1 Diabetes Mellitus(Clinical and Diagnostic Aspects)

Farhan¹,

Al-Zubaidi²,

Ghayyib³

2018

J Clin Gastroenterol Hepatol

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Background: Fatty liver occurs due to the excess fat in liver cells. The patient has a fatty liver when fat makes up at least 5% of the liver, benign condition of simple fatty liver usually does not lead to liver damage, while accumulation of large amount of simple fat may lead to scarring, inflammation and fibrosis of the liver. Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in developed as well as developing countries. The matter of the association between liver disease and diabetes mellitus is surging all over the world. Aim of study:To estimate the frequency and distribution of fatty liver disease in children and adolescents with type 1 diabetes mellitus.Patients and methods: Fifty children and adolescents with type 1 diabetes with mean age 10.5 ± 4.011 in range (3-18) year who were followed up in the diabetic clinic of Children Welfare Teaching Hospital in Baghdad have been examined to detect fatty liver disease, from 1st of June 2016 to 1st of December 2016. History was taken, physical examination was performed, and liver function tests, fasting lipid profile, HbA1C, and ultrasound of the liver were done. And by applying the NAFLD fibrosis scoring formula there were three groups of patients (F0-F2) with no fibrosis, (F2-F3) with intermediate score of fibrosis and (F3-F4) with presence of fibrosis.Results: There were 50 patients with type 1 DM included in this study; thirty females and 20 males. Thirteen (26%) of them have hepatomegaly while 37 (74%) with normal liver size and texture as detected by abdominal ultrasound. According to the result of NFS (NAFLD fibrosis score) formula and abdominal ultrasound, 5 (38.5%) of the patients with hepatomegaly showed presence of fibrosis, 5 (38.5%) showed intermediate score, while 3 (23%) showed no fibrosis which represent the false negative value while the patients with normal liver 27 (73%) showed no fibrosis and 10 (27%) showed intermediate score which represent the false positive value. Conclusion:The study clarified that the prevalence of fatty liver disease among type 1 diabetic patients was 10% depending on abdominal ultrasound, lipid profile, liver enzymes and NAFLD fibrosis scoring formula.

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Section: Patient and Methodsmentioning

confidence: 99%

“…The 'two hit hypothesis' proposed in 1998 consists of a first hit of liver fat accumulation which is caused by an imbalance in uptake and synthesis of hepatic lipids on the one hand and export and oxidation on the other in the context of IR [9]. The steatotic liver is then thought to be more vulnerable to a 'second hit'.…”

Section: Introductionmentioning

confidence: 99%

Fatty Liver Disease in Children and Adolescents with Type 1 Diabetes Mellitus(Clinical and Diagnostic Aspects)

Farhan¹,

Al-Zubaidi²,

Ghayyib³

2018

J Clin Gastroenterol Hepatol

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“…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). At our institution, we have utilized over the last 11 years PCH in patients with diffuse portal vein thrombosis undergoing liver transplantation when alternative techniques such as thrombectomy or venous interposition graft were not immediately applicable.…”

Section: Introductionmentioning

confidence: 99%

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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“…Various techniques employed to prevent portal vein thrombosis are hyper-reduction of grafts, having a good outflow of the graft, avoiding primary closure of the abdomen, identification and ligation of shunts if any, anastomosing at the splenic vein + superior mesenteric vein junction so as to have widest possible anastomosis and use of anticoagulation in the post-operative period. In spite of all these preventive measures the portal flow can still be low [8]. In such situations non physiological operations like arterialization of portal vein, Reno-portal anastomosis, cavoportal hemi transposition are employed to salvage the graft.…”

Section: Resultsmentioning

confidence: 99%

Thrombosed Cavo-Portal Hemi-Transposition Salvaged by Digital Subtraction Angiography and Self Expanding Metallic Stent Deployment-Report of First Case and Review of Literature

Selvakumar¹,

Gupta²,

Rastogi³

2017

J Gastrointest Dig Syst

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Cavo Portal Hemi-Transposition (CPHT) is a surgical technique used in liver transplantation (LT) to salvage low portal perfusion situations. Although non physiological it is an established surgical technique for over two decades for the aforementioned clinical situation. CPHT also may fail. Our patient was a 6 months old male child with decompensated cirrhosis secondary to extra hepatic biliary atresia. Intraoperatively there was recurrent thrombosis of portal vein anastomosis. Hence portal flow of the graft was salvaged by CPHT. However, in the immediate postoperative period there was thrombosis of CPHT. Emergency angiography and stenting of CPHT was done. At 3 years post LT the child has stable graft function and good quality of life. This is the first case of this kind to be reported in the literature.

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Portocaval hemitransposition in pediatric liver transplant recipients: A single-center experience

Cited by 13 publications

References 43 publications

Fatty Liver Disease in Children and Adolescents with Type 1 Diabetes Mellitus(Clinical and Diagnostic Aspects)

Fatty Liver Disease in Children and Adolescents with Type 1 Diabetes Mellitus(Clinical and Diagnostic Aspects)

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

Thrombosed Cavo-Portal Hemi-Transposition Salvaged by Digital Subtraction Angiography and Self Expanding Metallic Stent Deployment-Report of First Case and Review of Literature

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