Management of Large, Spontaneous Portosystemic Shunts in Liver Transplantation: Case Report and Review of Literature.

Autor: Miranda PB; HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain. Electronic address: pablobm81@hotmail.es., Artacho GS; HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain., Bellido CB; HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain., Marín Gómez LM; HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain., Franco CC; HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain., Álamo Martinez JM; HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain., Padillo Ruiz FJ; HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain., Gómez Bravo MÁ; HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain.
Jazyk: angličtina
Zdroj: Transplantation proceedings [Transplant Proc] 2020 Mar; Vol. 52 (2), pp. 566-568. Date of Electronic Publication: 2020 Feb 10.
DOI: 10.1016/j.transproceed.2019.11.049
Abstrakt: Background: The presence of collateral circulation in liver cirrhosis patients with portal hypertension is quite frequent due to re-permeabilization of closed embryonic channels. In some cases, these shunts could measure over 1 cm wide, therefore, containing a significative blood flow. Its management during liver transplantation could be challenging due to possible complications resulting from either ligation of the shunts or from ignoring them. We present the case of a patient with recurrent hepatic encephalopathy (HE) and a large spontaneous portosystemic shunt (SPSS) who submitted to liver transplant and review the literature identifying options, complications, and outcomes with the aim of facilitating decision making.
Material and Methods: A 68-year-old, Spanish man diagnosed with liver cirrhosis with portal hypertension and recurrent episodes of HE is proposed for LT. The patient's Child-Pugh score was A6-B7, and the Model for End-stage Liver Disease score was 12. Preoperatively, a computed tomography scan showed a large SPSS running to the inferior cava vein. During the surgery, a small-sized portal vein and a large shunt measuring almost 3 cm wide were identified. After reperfusion, portal vein flow was 1000 to 1100 mL/min. Owing to the previous HE and the risk of low portal flow, the shunt was closed increasing the portal flow to 1800 mL/min. The patient was discharged without any complications.
Conclusions: The presence of large SPSSs are frequent during LT. Decision making intraoperatively can be challenging due to possible complications derived from ligation of the SPSS or from ignoring it. Either preoperative assessment of a further HE risk or portal vein flow measurement after reperfusion are essential to achieve a correct resolution.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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