Results of liver transplantation in patients with previous portosystemic shunts.
BACKGROUND
Although liver transplantation is performed successfully in some patients with previous portosystemic shunts (PSS), these surgical procedures have been considered a relative contraindication for orthotopic liver transplantation (OLT). We aimed to determine whether a previous PSS worsens the prognosis of patients who undergo OLT.


METHODS
Between March 1986 and October 2003, 520 liver transplants were performed in 467 patients in our center. Thirteen patients had undergone a PSS before OLT. The types of PSS were: portocaval (n = 8), splenorenal (n = 3), mesocaval (n = 1), and portoatrial (n = 1). We compared patients with previous PSS (cases) and the three patients with an OLT immediately before each case (controls). We analyzed the following variables: age, Child-Pugh stage, pretransplant liver disease, surgical times, transfusion requirements, infections, intensive care unit (ICU) stay, postoperative evolution, and survival.


RESULTS
Age, Child-Pugh stage, and pretransplant liver disease were similar in both groups. There were no statistical differences in age, surgical times, ischemia time, anhepatic phase, transfusion requirements, ICU stay, infections, or hospital stay. The postoperative course was similar in both groups. Long-term survival was 84.62% in cases versus 78.5% in controls.


CONCLUSIONS
Previous PSS should not be considered a contraindication for liver transplantation, even though this group of patients involves a special surgical challenge.
Rubio Gonzalez
E E
EE
Liver Transplant Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain. ruge73@hotmail.com
Moreno Planas
J M
JM
Jimenez Garrido
M C
MC
Lucena de la Poza
J L
JL
Martínez Arrieta
F
F
Cuervas-Mons
V
V
Sanchez Turrión
V
V
D005260:Female; D006526:Hepatitis C / Q000601:surgery / Q000628:therapy; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery / Q000628:therapy; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011168:Portal System; D011170:Portasystemic Shunt, Surgical / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome