Impact of prior portosystemic shunt procedures on outcome of liver transplantation.
BACKGROUND
Cirrhotic patients may require portosystemic shunts as treatment for complications of portal hypertension. The aim of this study was to asses how these procedures may influence the orthotopic liver transplantation procedure and its outcome.


METHODS
Forty-five patients with a previous portosystemic shunt were divided into 3 groups (group 1, 19 with a portocaval shunt; group 2, 4 with a mesocaval shunt and 5 with a distal splenorenal shunts; group 3, 17 with a transjugular intrahepatic portosystemic shunt). Forty-five patients without a shunt, matched for age, gender, pretransplant liver status, and year of transplantation, were selected as controls. Surgical time, transfusional requirement, intensive care unit and total hospital duration of stay, complications, retransplantation rate, and short- and long-term mortality were analyzed.


RESULTS
Group 1 showed a significantly longer surgical time, higher red blood cell transfusional requirements, longer intensive care unit and hospital stay, and greater short and long-term mortality than the controls. No significant differences were observed between groups 2 and 3 and the controls.


CONCLUSIONS
In cirrhotic patients, surgically created portosystemic shunts involving the hepatic hilum have a negative impact on liver transplantation. This operation should be avoided in potential liver transplant candidates; surgical shunts that do not compromise the hepatic hilum or transjugular intrahepatic portosystemic shunts are preferred.
Dell'Era
Alessandra
A
Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Spain.
Grande
Luis
L
Barros-Schelotto
Pablo
P
Turnes
Juan
J
Fuster
Josep
J
Charco
Ramón
R
García-Valdecasas
Juan-Carlos
JC
Bosch
Jaime
J
García-Pagán
Juan-Carlos
JC
D016022:Case-Control Studies; D003422:Critical Care; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000379:methods; D011182:Postoperative Care; D013997:Time Factors; D016896:Treatment Outcome