Premium
Triple‐phase computed tomography and intraoperative flow measurements improve the management of portosystemic shunts during liver transplantation
Author(s) -
Aucejo Federico N.,
Hashimoto Koji,
Quintini Cristiano,
Kelly Dympna,
Vogt David,
Winans Charles,
Eghtesad Bijan,
Baker Mark,
Fung John,
Miller Charles
Publication year - 2008
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21377
Subject(s) - medicine , portosystemic shunt , thrombosis , liver transplantation , cirrhosis , ligation , shunt (medical) , portal vein thrombosis , surgery , radiology , transplantation , artery , portal hypertension
Abstract Ligation of portosystemic shunts in patients with cirrhosis undergoing liver transplantation has been recommended to avoid insufficient portal vein (PV) flow. Shunts are not always recognized pretransplantation because intraoperative PV flow assessment is not routinely attempted. As a result of a posttransplantation PV thrombosis in a recipient with a large portosystemic shunt and a PV flow <1 L/minute, we employed triple‐phase computed tomography with vascular reconstruction and intraoperative graft flow measurement to determine the need for inflow modification in our next 16 patients with large portosystemic shunts. Subsequently, 6 patients with large portosystemic shunts and PV flows ≤1 L/minute underwent inflow modification at the time of transplantation to improve venous graft inflow. One patient with PV thrombosis had PV replacement without shunt ligation. Two patients with large splenorenal shunts and extensive PV thrombosis had left renoportal bypass. In 7 patients with large portosystemic shunts and PV flow greater than 1 L/minute, inflow modification was not attempted, to avoid excessive venous inflow that could jeopardize hepatic artery flow via the hepatic artery buffer response. In conclusion, sustained good graft function and inflow were achieved in all 16 patients. Liver Transpl 14:96–99, 2008. © 2007 AASLD.