title: Graft loss and poor outcomes after living-donor liver transplantation owing to arterioportal shunts caused by liver needle biopsies.
abstract: BACKGROUND
  Arterioportal shunts (APS) are well-known critical complications after liver transplantation (OLT). The aims of this study were to assess the frequency and causes of APS after OLT and to analyze APS patients with poor outcomes.
  
  
  METHODS
  We evaluated 1415 OLT recipients retrospectively investigating APS cases.
  
  
  RESULTS
  APS were detected in at least 9 patients (0.6%). All patients with APS had a history of posttransplant invasive procedures; percutaneous transhepatic cholangio drainage (n = 6) or needle biopsy (LNB; n = 3). Two patients with poor outcomes showed proximal APS caused by LNBs. The other 7 patients with distal APSs, showed stable conditions. Imaging findings in the 2 proximal APS patients revealed drastic changes in graft hemodynamics. Although they finally underwent re-OLT, their outcomes were poor, owing to fatal complications associated with advanced collaterals.
  
  
  CONCLUSIONS
  We concluded that even careful LNBs can cause APS at unexpected points. Earlier, more aggressive treatments are required, especially for proximal APS patients.
authors.affiliation: Department of Surgery, Kyoto University Hospital, Japan. horit@kuhp.kyoto-u.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Hori
authors.forename: M
authors.initials: M
authors.lastname: Ueda
authors.forename: F
authors.initials: F
authors.lastname: Oike
authors.forename: Y
authors.initials: Y
authors.lastname: Ogura
authors.forename: K
authors.initials: K
authors.lastname: Ogawa
authors.forename: J H
authors.initials: JH
authors.lastname: Nguyen
authors.forename: Y
authors.initials: Y
authors.lastname: Yonekawa
authors.forename: Y
authors.initials: Y
authors.lastname: Takada
authors.forename: H
authors.initials: H
authors.lastname: Egawa
authors.forename: A
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: L
authors.initials: L
authors.lastname: Sibulesky
authors.forename: D
authors.initials: D
authors.lastname: Balci
authors.forename: F
authors.initials: F
authors.lastname: Chen
authors.forename: A-M T
authors.initials: AM
authors.lastname: Baine
authors.forename: S
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D001707:Biopsy, Needle / Q000009:adverse effects*; D002648:Child; D002780:Cholestasis, Intrahepatic / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation; D017809:Fatal Outcome; D006801:Humans; D007223:Infant; D008100:Liver Abscess / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome