Portocaval hemitransposition in pediatric liver transplant recipients: A single-center experience

Gerald S. Lipshutz, Supriya Patel, Jonathan R. Hiatt, Hassan Yersiz, Douglas G. Farmer, Sue V. McDiarmid, R. Mark Ghobrial, Ronald W. Busuttil

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Few studies have reported a series of patients who have undergone portocaval hemitransposition at the time of orthotopic liver transplantation (OLT). Furthermore, no series report the outcome of pediatric patients who required the procedure. This work analyzes the experience with portocaval hemitransposition in the pediatric liver transplant population at a single center since the initial description of the procedure. We carried out a retrospective analysis of all pediatric liver transplants performed in our institution during the 8-year period from January 1, 1997, to December 31, 2004. Of 320 pediatric patients who received OLT during the study period, 7 underwent portocaval hemitransposition (2.2%). Five of the patients had biliary atresia. Four grafts were whole cadaveric livers, while the remaining 4 were left lateral segments from either in situ cadaveric split (n = 3) or living donation (n = 1). One patient received a whole cadaveric allograft and was retransplanted with a segment 2/3 graft; in both cases portocaval hemitransposition was utilized. Average warm ischemia time was 54 ± 16 minutes. Three patients had primary nonfunction of the allograft; 2 were retransplanted with successful outcome, and the remaining patient died before retransplantation. Another patient died from recurrent disease. Four of 7 are long-term survivors and demonstrate good liver function as long as 8 years posttransplant. In conclusions, long-term survival is possible following OLT with portocaval hemitransposition in pediatric patients. However, rates of primary graft nonfunction can be high. Appropriate selection of recipient and type of donor graft are essential for good outcomes. Portocaval hemitransposition should be used cautiously and as a last resort to establish portovenous inflow.

Original languageEnglish (US)
Pages (from-to)1097-1103
Number of pages7
JournalLiver Transplantation
Volume12
Issue number7
DOIs
StatePublished - Jul 2006

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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