title: Recurrent portal hypertension after composite liver/small bowel transplantation.
abstract: Late technical complications of composite liver/small bowel transplantation procedures are often complex and have not been well defined. Here we describe the unusual presentation and management of two cases of recurrent thrombocytopenia due to hypersplenism resulting from portacaval shunt stenosis. Both patients presented with portal hypertension late after composite liver/small bowel transplantation. One patient presented with recurrent bouts of upper gastrointestinal hemorrhage and was ultimately found to have a stenosis of her native portacaval shunt. After unsuccessful balloon dilatation of the anastomosis, a successful side-to-side distal splenorenal shunt was performed. The second patient presented with severe thrombocytopenia, the etiology of which was determined to be a short segment occlusion of the inferior vena cava between the native portacaval shunt and the piggyback outflow anastomosis of the liver graft. Total caval occlusion prevented balloon dilatation; the patient was relisted for transplantation but died of chronic rejection four months later. Recurrent portal hypertension is challenging in patients who have had combined liver/small bowel transplantation. Surgeons performing intestinal transplantation need to be increasingly aware of these possible late complications.
authors.affiliation: Recanati/Miller Transplantation Institute, The Mount Sinai School of Medicine, New York, NY, USA. thomas.fishbein@mountsinai.org
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Fishbein
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gondolesi
authors.forename: Neal S
authors.initials: NS
authors.lastname: Leleiko
authors.forename: Harold A
authors.initials: HA
authors.lastname: Mitty
authors.forename: Allan
authors.initials: A
authors.lastname: Tschernia
authors.forename: Stuart S
authors.initials: SS
authors.lastname: Kaufman
mesh_terms: D000714:Anastomosis, Surgical; D017809:Fatal Outcome; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006084:Graft Rejection; D006801:Humans; D006971:Hypersplenism / Q000209:etiology; D006975:Hypertension, Portal / Q000209:etiology*; D007223:Infant; D007422:Intestines / Q000098:blood supply / Q000637:transplantation*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D011859:Radiography; D012008:Recurrence; D013164:Splenorenal Shunt, Surgical; D013921:Thrombocytopenia / Q000209:etiology; D014648:Varicose Veins / Q000209:etiology; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D014682:Vena Cava, Inferior