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Liver transplantation in patients with previous portasystemic shunt

Mazzaferro, V and Todo, S and Tzakis, AG and Stieber, AC and Makowka, L and Starzl, TE (1990) Liver transplantation in patients with previous portasystemic shunt. The American Journal of Surgery, 160 (1). 111 - 116. ISSN 0002-9610

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Abstract

Over a 9-year period, 58 patients who had previous portasystemic shunt procedures underwent orthotopic liver transplantation (OLTx) under a cyclosporine-steroid immunosuppressive regimen. The types of shunt used were distal splenorenal (18 patients), mesocaval (17 patients), end-to-side portacaval (11 patients), side-to-side portacaval (5 patients) and proximal splenorenal (7 patients). The mean interval between shunt and transplantation was 6 years. There was no statistical difference in survival between patients with previous shunts and the entire population of patients with primary liver transplantation performed during the same period of time. Age, sex, shunt patency, status of portal vein, and use of vein or artery graft did not affect survival. Child's classification had a significant influence on graft survival, even though no difference was subsequently observed in patient survival. A progressively improved intraoperative strategy and the use of veno-venous bypass and University of Wisconsin preservation solution had a significant impact on blood loss, length of operation, length of stay in intensive care unit, and ultimately, on survival. Distal splenorenal and mesocaval shunts with no or minimal hilum dissection are safer shunts if subsequent transplantation is planned; in fact, their 9-year survival was 87%, whereas all other shunts were associated with a survival no better than 52% (p<0.006). © 1990 Reed Publishing USA.

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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Mazzaferro, V
Todo, S
Tzakis, AG
Stieber, AC
Makowka, L
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1990
Date Type: Publication
Journal or Publication Title: The American Journal of Surgery
Volume: 160
Number: 1
Page Range: 111 - 116
DOI or Unique Handle: 10.1016/s0002-9610(05)80879-7
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0002-9610
Other ID: uls-drl:31735062116458, Starzl CV No. 1091
Date Deposited: 08 Apr 2010 17:18
Last Modified: 02 Feb 2019 13:57
URI: http://d-scholarship.pitt.edu/id/eprint/4477

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