The outcome of living donor liver transplantation with prior spontaneous large portasystemic shunts

Shinmoto, Hiroshi; Yagi, T.; Matsukawa, Hiroyoshi; Matsuda, Hiroaki; Shinoura, Susumu; Umeda, Yuzo; Inomata, Takayuki; Satoh, Daisuke; Tanaka, Noriaki

doi:10.1111/j.1432-2277.2007.00593.x

Cited by 33 publications

(55 citation statements)

References 29 publications

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“…1,2,5,8,10,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] Possible treatment options include preoperative further selective shunting of flow such as transjugular intrahepatic portosystemic shunts, intraoperative assessment of portal flow with a decision to intervene if there is evidence of inadequate flow to the allograft, automatic intraoperative ligation of the shunt, close monitoring of the shunt and the functional status of the transplant liver without intervention, creation of portorenal anastomosis in the case of portal vein thrombosis, or postoperative percutaneous interventions to embolize a symptomatic shunt. …”

Section: Interventionmentioning

confidence: 99%

“…Additionally, shunts may reconstitute, and the steal may worsen if the intrinsic allograft vascular resistance becomes elevated, as may occur with rejection, fluid overload, and other posttransplant phenomena. [10][11][12] Splenorenal shunts are of particular concern as they tend to be large and may go undetected at the time of transplant. Nonetheless, it remains controversial as to whether the persistence of porto-systemic collaterals and vascular steal is uniformly detrimental to long-term allograft function.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Management of Spontaneous Splenorenal Shunts in Orthotopic Liver Transplant Patients

Awad

Horrow²,

Parsikia³

et al. 2012

Exp Clin Transplant

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Objectives: Spontaneous splenorenal shunts cause significant vascular steal from the liver. There is no accepted algorithm for treating spontaneous splenorenal shunts before, during, or after liver transplant, and evidence for efficacy of treatments remains limited. Materials and Methods: We reviewed the literature, and our institution's experience regarding spontaneous splenorenal shunts, including a case series of 6 patients with spontaneous splenorenal shunts undergoing transjugular intrahepatic portosystemic shunts, a case of intraoperative ligation of a large spontaneous splenorenal shunts during transplant, and 1 patient requiring multiple endovascular interventions to embolize recurrent spontaneous splenorenal shunts after orthotopic liver transplant.

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Section: Interventionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perioperative Management of Spontaneous Splenorenal Shunts in Orthotopic Liver Transplant Patients

Awad

Horrow²,

Parsikia³

et al. 2012

Exp Clin Transplant

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“…[10][11][12] However, large portosystemic shunts such as SSRSs may jeopardize the portal flow and lead to graft dysfunction due to portal hypoperfusion. 13 The optimal surgical approach to SSRSs has not been well defined. 14 In order to determine when these shunts should be closed to prevent portal hypoperfusion, portal flow and portal pressure measurements should be obtained before and after reperfusion.…”

mentioning

confidence: 99%

Hemodynamic consequences of spontaneous splenorenal shunts in deceased donor liver transplantation

2011

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The presence of large spontaneous splenorenal shunts (SSRSs) is a risk factor for poor portal vein flow and liver dysfunction. The disconnection of splenorenal shunts by left renal vein (LRV) ligation has been suggested as a potential solution for improving portal flow. We reviewed the hemodynamic consequences of splenorenal shunts in deceased donor liver transplantation and investigated the role of LRV ligation. In 10 patients who underwent liver transplantation at our institution between January 2006 and April 2010, an SSRS was diagnosed preoperatively. Intraoperative portal and hepatic artery flows were measured with a transit time flowmeter. The shunt was disconnected in 6 patients for whom the portal flow after reperfusion was less than or equal to 1200 mL/minute. LRV ligation resulted in significant increases in the portal flow. There were no differences in renal function for the patients who underwent renal vein ligation and the patients who did not undergo ligation. In conclusion, LRV ligation disconnects splenorenal shunts and modulates the portal inflow without any detrimental effects on renal function. Liver Portal hypertension leads to the development of an extensive network of portosystemic collateral vessels. In 5% to 12% of patients, these collaterals include spontaneous splenorenal shunts (SSRSs).

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“…A portosystemic shunt could decrease the portal vein flow after liver transplantation, leading to the subsequent formation of portal vein thrombosis, graft atrophy and other serious consequences [5,6].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the presence of a shunt can have a positive effect on the liver perfusion in cases with relative portal hypertension in the early postoperative period, especially after LDLT [5,7]. Moreover, even after shunt vessel ligation during LDLT, there is still chance of recurrence after surgery and this procedure might be ineffective [8].…”

Section: Discussionmentioning

confidence: 99%

Effective balloon-occluded retrograde transvenous obliteration of the superior mesenteric vein–inferior vena cava shunt in a patient with hepatic encephalopathy after living donor liver transplantation

Baimakhanov

Soyama

Takatsuki

et al. 2014

Clin J Gastroenterol

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Balloon-occluded retrograde transvenous obliteration (BRTO) has become a common and effective procedure for treating hepatic encephalopathy due to a portosystemic shunt related to cirrhosis of the liver. However, this method of treatment has rarely reported in patients after liver transplantation. We herein report the case of a 52-year-old patient who underwent living donor liver transplantation (LDLT) due to a hepatitis C virus-infected hepatocellular carcinoma that was complicated with portal vein thrombosis and a large portosystemic shunt between the superior mesenteric vein (SMV) and inferior vena cava (IVC). The SMV-IVC shunt was not obliterated during LDLT because there was sufficient portal flow into the graft after reperfusion. However, the patient was postoperatively complicated with encephalopathy due to the portosystemic shunt. BRTO was performed and was demonstrated to have effectively managed the encephalopathy due to the SMV-IVC shunt, while preserving the hepatic function after LDLT.2 Baimakhanov et al.

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The outcome of living donor liver transplantation with prior spontaneous large portasystemic shunts

Cited by 33 publications

References 29 publications

Perioperative Management of Spontaneous Splenorenal Shunts in Orthotopic Liver Transplant Patients

Perioperative Management of Spontaneous Splenorenal Shunts in Orthotopic Liver Transplant Patients

Hemodynamic consequences of spontaneous splenorenal shunts in deceased donor liver transplantation

Effective balloon-occluded retrograde transvenous obliteration of the superior mesenteric vein–inferior vena cava shunt in a patient with hepatic encephalopathy after living donor liver transplantation

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