| Popis: |
To investigate the efficacy of plug-assisted retrograde transvenous obliteration (PARTO) for portal steal from complicated portosystemic shunts (PSS) in living-donor liver transplantation (LDLT).This retrospective study included consecutive patients who underwent LDLT and intraoperative or postoperative PARTO for complicated PSS between January 2020 and December 2021. PARTO was performed when hepatofugal portal flow steal was identified during intraoperative cine-portography, and afferent vein embolization was difficult due to multiple afferent veins or incomplete afferent vein embolization. Liver volume, complete obliteration of a PSS, technical success, adverse events, and follow-up clinical and laboratory data were evaluated.Thirty-seven patients were included, and the technical success rate was 100% with no major adverse events. During the median follow-up of 20.0 months, all patients recovered well with suitable regeneration of the liver without graft dysfunction related to a portal steal. Liver volume was significantly increased within one month (median 956 mL vs. 1198 mL, P0.001). Complete obliteration of a PSS occurred in 97.3% (36/37) of patients, and there was no recurrence during follow-up. The Child-Pugh score, serum albumin and total bilirubin levels, and prothrombin time showed significant improvement over serial follow-up. Compared with pre-procedural values (14.9 cm/s), follow-up portal flow (median) peaked on the first day (71.2 cm/s, P0.001), then remained significantly higher at one week (60.3 cm/s, P0.001) and one month (53.1 cm/s, P0.001), in accord with the graft regeneration.PARTO is an effective procedure for the treatment of complicated PSS in LDLT. |
