Endovascular closure of a hemiportocaval shunt after small-for-size adult-to-adult left lobe living donor liver transplantation.
Adult-to-adult living donor liver transplantation is an accepted treatment option for patients with end-stage liver disease. It is generally acknowledged that a graft weight to recipient body weight ratio > 0.8 is required in order to prevent the development of small-for-size syndrome. Size mismatch, however, is not the only factor responsible for the syndrome; instead, it results from a combination of factors, including the size, recipient status, and degree of portal hypertension. The ability to modulate the portal venous inflow has sparked renewed interest in the left lobe graft. We have used the hemiportocaval shunt, as described by Troisi et al. (Am J Transplant 2005;5:1397-1404), in left lobe living donor liver transplants in order to prevent small-for-size syndrome while enhancing the safety of the donor operation. In this report, we describe a novel technique for occluding a hemiportocaval shunt in a patient who developed hepatic encephalopathy after receiving a small-for-size left lobe liver allograft from a living donor.
Botha
Jean F
JF
Division of Transplantation, University of Nebraska Medical Center, Omaha, NE 68198, USA. jbotha@unmc.edu
Campos
B Daniel
BD
Johanning
Jason
J
Mercer
David
D
Grant
Wendy
W
Langnas
Alan
A
D000328:Adult; D019917:Blood Vessel Prosthesis Implantation; D001835:Body Weight; D005260:Female; D006498:Hepatectomy; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D009929:Organ Size; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects; D013577:Syndrome; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*