title: Emergency portacaval shunt for control of hemorrhage from a parenchymal fracture after adult-to-adult living donor liver transplantation.
abstract: As more adults undergo transplantation with partial liver grafts, the unique features of these segments and their clinical significance will become apparent. A patient presented with life-threatening hemorrhage from an iatrogenic laceration to a right lobe graft 11 days after transplantation. The creation of a portacaval shunt effectively controlled the bleeding, allowing more elective replacement of the organ with another right lobe graft. The regeneration process combined with increased portal blood flow and relative outflow limitation may have set the stage for this complication. Any disruption of the liver parenchyma during transplantation should be securely repaired and followed cautiously. Portacaval shunting is an option for controlling hemorrhage from the liver in transplant recipients. The timely availability of a second organ was likely the ultimate determinant of survival for this patient.
authors.affiliation: Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond 23219, USA.
authors.forename: A
authors.initials: A
authors.lastname: Marcos
authors.forename: R A
authors.initials: RA
authors.lastname: Fisher
authors.forename: J M
authors.initials: JM
authors.lastname: Ham
authors.forename: A T
authors.initials: AT
authors.lastname: Olzinski
authors.forename: M L
authors.initials: ML
authors.lastname: Shiffman
authors.forename: A J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: V A
authors.initials: VA
authors.lastname: Luketic
authors.forename: R K
authors.initials: RK
authors.lastname: Sterling
authors.forename: M P
authors.initials: MP
authors.lastname: Posner
mesh_terms: D000328:Adult; D004630:Emergencies; D005260:Female; D006470:Hemorrhage; D006801:Humans; D007049:Iatrogenic Disease; D008107:Liver Diseases; D008115:Liver Regeneration; D016031:Liver Transplantation; D019520:Living Donors; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D011183:Postoperative Complications; D012086:Reoperation