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The new method of time-lag ligation for portosystemic shunt using coronary artery bypass graft occluder for adult living donor liver transplantation.

Abstract：

:We performed a living donor liver transplantation (LDLT) for a 57-year-old man who had end-stage liver failure with portal hypertension and an inferior mesenteric vein-left testicular vein (IMV-LTV) shunt. At operation, we did not clamp the shunt but encircled it with a coronary artery bypass graft (CABG) occluder (Sumitomo Bakelite K.K., Japan), which was passed outside the body through the abdominal wall to time-lag ligation (TLL). On postoperative day (POD) 5, we observed decreased portal flow. We performed TLL of the shunt using the CABG occluder without re-laparotomy. The portal flow increased, while the portal vein pressure increased slightly. In LDLT, portosystemic shunt has been reported to be a cause of portal thrombus formation or graft liver atrophy due to decreased PV flow in the mid postoperative period. However, perioperative ligation of a portosystemic shunt may prevent regeneration of the grafted liver because of excessive portal hypertension. Therefore the technique of time-lag ligation of a portosystemic shunt using a CABG occluder may be a minimally invasive, useful method to achieve physiological liver graft regeneration.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Kokai H,Sato Y,Yamamoto S,Oya H,Nakatsuka H,Kobayashi T,Watanabe T,Takizawa K,Hatakeyama K

doi

10.1016/j.transproceed.2009.08.055

subject

Has Abstract

pub_date

2009-12-01 00:00:00

pages

4259-61

issue

10

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(09)01322-0

journal_volume

41

pub_type

杂志文章

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