TY - JOUR
T1 - The role of spontaneous portal-systemic shunts in liver transplantation
T2 - Case report and literature review
AU - Wang, Tielong
AU - Gong, Jinlong
AU - Chen, Zhitao
AU - Huang, Changjun
AU - Yu, Jia
AU - Guo, Zhiyong
AU - He, Xiaoshun
N1 - Funding Information:
Funding: This work was supported by grants as follows: the
Funding Information:
This work was supported by grants as follows: the National Natural Science Foundation of China (81970564, 81471583 and 81570587), the Key Clinical Specialty Construction Project of National Health and Family Planning Commission of the People?s Republic of China, the Guangdong Provincial Key Laboratory Construction Projection on Organ Donation and Transplant Immunology (2013A061401007, 2017B030314018), Guangdong Provincial international Cooperation Base of Science and Technology (Organ Transplantation) (2015B050501002), Guangdong Provincial Natural Science Funds for Major Basic Science Culture Project (2015A030308010), Guangdong Provincial Natural Science Funds for Distinguished Young Scholars (2015A030306025), Special support program for training high level talents in Guangdong Province (2015TQ01R168), Pearl River Nova Program of Guangzhou (201506010014), Science and Technology Program of Guangzhou (201704020150), Sun Yat-sen University Young Teacher Key Cultivate Project (17ykzd29) and ?Elite program? specially supported by China organ transplantation development foundation.
Publisher Copyright:
© Annals of Palliative Medicine. All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - We described two liver transplants for patients with end-stage liver disease and spontaneous portal-systemic shunt (SPSS). We ligated the splenorenal shunt (SRS) in the first case but did not ligate it in the second case. Postoperative examination revealed significant differences in portal blood flow velocity, serum ammonia level, liver function and prognosis between two cases. The portal blood flow in the first case was sufficient with decreased serum ammonia and immediate liver graft function. The portal blood flow was insufficient and serum ammonia level was not significantly reduced after operation in the second case probably because SRS was still present after surgery. The first case recovered well after operation and was discharged uneventfully, however, the second patient suffered early allograft dysfunction (EAD) after operation and died of pulmonary infection on postoperative day (POD) 18. Proper management of SPSS in liver transplantation (LT) is important because it can affect the function of liver graft and patient prognosis, so we reviewed the relevant literature and list different types of SPSS and their clinical characteristics. We recommend that SPSS greater than 8 mm in diameter should be ligated in LT with non-small size graft to ensure adequate portal flow and preserved with small size liver graft to avoid portal hypertransfusion and portal hypertension except obviously insufficient portal blood flow.
AB - We described two liver transplants for patients with end-stage liver disease and spontaneous portal-systemic shunt (SPSS). We ligated the splenorenal shunt (SRS) in the first case but did not ligate it in the second case. Postoperative examination revealed significant differences in portal blood flow velocity, serum ammonia level, liver function and prognosis between two cases. The portal blood flow in the first case was sufficient with decreased serum ammonia and immediate liver graft function. The portal blood flow was insufficient and serum ammonia level was not significantly reduced after operation in the second case probably because SRS was still present after surgery. The first case recovered well after operation and was discharged uneventfully, however, the second patient suffered early allograft dysfunction (EAD) after operation and died of pulmonary infection on postoperative day (POD) 18. Proper management of SPSS in liver transplantation (LT) is important because it can affect the function of liver graft and patient prognosis, so we reviewed the relevant literature and list different types of SPSS and their clinical characteristics. We recommend that SPSS greater than 8 mm in diameter should be ligated in LT with non-small size graft to ensure adequate portal flow and preserved with small size liver graft to avoid portal hypertransfusion and portal hypertension except obviously insufficient portal blood flow.
KW - Hepatic encephalopathy (HE)
KW - Liver transplantation (LT)
KW - Small-for-size syndrome (SFSS)
KW - Splenorenal shunt (SRS)
KW - Spontaneous portal-systemic shunt (SPSS)
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U2 - 10.21037/apm-20-2431
DO - 10.21037/apm-20-2431
M3 - Article
C2 - 33832286
AN - SCOPUS:85111397751
SN - 2224-5820
VL - 10
SP - 8365
EP - 8370
JO - Annals of Palliative Medicine
JF - Annals of Palliative Medicine
IS - 7
ER -