title: Two-stage liver transplantation with temporary porto-middle hepatic vein shunt.
abstract: Two-stage liver transplantation (LT) has been reported for cases of fulminant liver failure that can lead to toxic hepatic syndrome, or massive hemorrhages resulting in uncontrollable bleeding. Technically, the first stage of the procedure consists of a total hepatectomy with preservation of the recipient's inferior vena cava (IVC), followed by the creation of a temporary end-to-side porto-caval shunt (TPCS). The second stage consists of removing the TPCS and implanting a liver graft when one becomes available. We report a case of a two-stage total hepatectomy and LT in which a temporary end-to-end anastomosis between the portal vein and the middle hepatic vein (TPMHV) was performed as an alternative to the classic end-to-end TPCS. The creation of a TPMHV proved technically feasible and showed some advantages compared to the standard TPCS. In cases in which a two-stage LT with side-to-side caval reconstruction is utilized, TPMHV can be considered as a safe and effective alternative to standard TPCS.
authors.affiliation: Department of Surgery and Transplantation, San Martino Hospital, University of Genoa, Monoblocco IV, Largo R. Benzi 10, 16132 Genoa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Varotti
authors.forename: Enzo
authors.initials: E
authors.lastname: Andorno
authors.forename: Marco
authors.initials: M
authors.lastname: Casaccia
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Domenico
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bottino
authors.forename: Pietro
authors.initials: P
authors.lastname: Diviacco
authors.forename: Nicola
authors.initials: N
authors.lastname: Morelli
authors.forename: Chiara
authors.initials: C
authors.lastname: Ferrari
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrante
authors.forename: Umberto
authors.initials: U
authors.lastname: Valente