title: Successful liver transplantation in a patient with a thrombosed portomesenteric system after multiple failed shunts.
abstract: Combined portal and mesenteric vein thrombosis preventing restoration of adequate portal venous flow has been considered a contraindication to liver transplantation. We report a patient with failed splenorenal (SR), portocaval (PC), and mesocaval (MC) shunts, who despite the absence of any obvious means for supplying portal venous inflow to a hepatic graft, successfully underwent orthotopic liver transplantation. A method of reconstruction of the portal vein with the use of vein grafts anastomosed to a large splanchnic venous collateral is described. This technique can be used in selected patients in whom orthotopic liver transplantation might otherwise be considered technically impossible.
authors.affiliation: Department of Surgery, University of Nebraska School of Medicine, Omaha.
authors.forename: P
authors.initials: P
authors.lastname: Castaldo
authors.forename: A N
authors.initials: AN
authors.lastname: Langnas
authors.forename: R J
authors.initials: RJ
authors.lastname: Stratta
authors.forename: R P
authors.initials: RP
authors.lastname: Lieberman
authors.forename: R P
authors.initials: RP
authors.lastname: Wood
authors.forename: B W
authors.initials: BW
authors.lastname: Shaw
mesh_terms: D000328:Adult; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000601:surgery; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D011170:Portasystemic Shunt, Surgical; D011859:Radiography; D013927:Thrombosis / Q000150:complications*