title: Severe fatty change of the graft liver caused by a portosystemic shunt of mesenteric varices.
abstract: Portosystemic shunt is a common complication in patients with portal hypertension. Mesenteric varix is one of the collaterals that can cause post-transplant liver dysfunction. In this case report, a 45-year-old woman underwent living relative donor liver transplantation for alcoholic cirrhosis. Although the early postoperative course was uneventful, she was readmitted for treatment of liver hypofunction. Fatty change in the graft liver was confirmed by histopathology of the biopsy specimen. The venous phase of a superior mesenteric angiogram revealed large-caliber mesenteric varices comprising portosystemic venous shunts. Surgery was performed to ligate the shunts. The intraoperative color Doppler ultrasonography showed hepatofugal portal blood flow, which was corrected to hepatopetal blood flow by clamping the shunt vessels. The portal pressure was moderately elevated from 13.6 cm to 21.8 cm H(2)O. Two shunt vessels were ligated and divided. Her liver function returned to nearly normal thereafter. We recommend that descending collaterals be divided during liver transplantation.
authors.affiliation: Department of Surgery II, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Japan. sekido@med.yokohama-cu.ac.jp
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekido
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takeda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morioka
authors.forename: Toru
authors.initials: T
authors.lastname: Kubota
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
mesh_terms: D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008642:Mesenteric Veins / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D014463:Ultrasonography; D014648:Varicose Veins / Q000473:pathology* / Q000601:surgery