title: Varicose bleeding after liver transplantation in a patient with severe portosystemic shunts.
abstract: Recipients for liver transplantation often have portosystemic shunts due to portal hypertension. It is an important problem whether such shunts should be ligated during operations. Ligating the shunts seems of benefit for increasing portal blood flow to the liver, but it is sometimes difficult technically, and it is invasive to the patient. We experienced a recipient with huge portosystemic shunts and no esophageal varices before living-related liver transplantation. Some shunts were ligated during operation to increase portal blood flow to the graft. Unfortunately, the patient suffered severe bleeding from esophagogastric varices after he underwent retransplantation owing to accidental liver failure. Based on our experience, extreme care should be exercised to avoid varicose bleeding after ligating the portosystemic shunts of liver transplantation patients.
authors.affiliation: Department of Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Nosaka
authors.forename: Kenichi
authors.initials: K
authors.lastname: Teramoto
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Toru
authors.initials: T
authors.lastname: Igari
authors.forename: Susumu
authors.initials: S
authors.lastname: Takamatsu
authors.forename: Toru
authors.initials: T
authors.lastname: Kawamura
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Inoue
authors.forename: Narihide
authors.initials: N
authors.lastname: Goseki
authors.forename: Shigeki
authors.initials: S
authors.lastname: Arii
authors.forename: Takehisa
authors.initials: T
authors.lastname: Iwai
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Inomata
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D003097:Collateral Circulation; D004932:Esophageal and Gastric Varices / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011169:Portal Vein / Q000473:pathology / Q000601:surgery; D012086:Reoperation