Effect of a prior portasystemic shunt on subsequent liver transplantation.

Abstract:

:Fifteen patients who had a prior portasystemic shunt underwent orthotopic liver transplantation. Shunt types were portacaval in six patients, H-graft mesocaval in six, distal splenorenal in two, and proximal splenorenal in one. Mean blood loss and hospital stay were highest in the portacaval group. Retransplants (two patients) and deaths (two patients) also were limited to this group. In this report, technical considerations, advantages, and disadvantages of the various shunt types are described. Management of patients with late stages of portal hypertension must include estimation of the effects of a portasystemic shunt on subsequent liver transplantation. It is concluded that portacaval shunts should be avoided in patients who may be considered for transplantation. Distal splenorenal shunts are best performed in younger patients with intractable variceal bleeding who are not expected to require transplantation in the near future. A mesocaval H-graft is the shunt of choice in patients who are current liver transplant candidates.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Brems JJ,Hiatt JR,Klein AS,Millis JM,Colonna JO,Quinones-Baldrich WJ,Ramming KP,Busuttil RW

doi

10.1097/00000658-198901000-00008

subject

Has Abstract

pub_date

1989-01-01 00:00:00

pages

51-6

issue

1

eissn

0003-4932

issn

1528-1140

journal_volume

209

pub_type

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