Posttransplantation portal thrombosis secondary to splenorenal shunt persistence.
OBJECTIVE
The aim of this study was to analyze our experience with portal vein thrombosis after liver transplantation with a persistent splenorenal shunt.


METHODS
The study population included 780 liver transplantations from 1990 to 2009. We analyzed the existence of portal vein thrombosis in the immediate posttransplant period, selecting cases with a persistent splenorenal shunt requiring surgery.


RESULTS
The incidence of posttransplant portal vein thrombosis was 1.41% (n=11), of which 3 (27%) had a splenorenal shunt as a possible cause (0.38% of the total). Two cases required liver retransplantation due to portal vein thrombosis, and the third a thrombectomy. In all cases the shunt was also closed. During the early postoperative follow-up of these 3 patients, 2 needed repeat surgeries because of a new portal vein thrombosis (thrombectomy) in one and a bilioperitoneum in the other. After a median follow-up of 11 months, the patients showed a good evolution with no primary graft dysfunction.


CONCLUSIONS
The portal steal phenomenon secondary to persistence of a splenorenal shunt promotes the occurrence of portal vein thrombosis. Although it is a rare cause of graft dysfunction, it must be treated early, because it can lead to a small-for-size syndrome.
Liver Transplant and Hepatobiliopancreatic Surgery Unit, General and Gastrointestinal Surgery Department, Hospitales Universitarios Virgen del Rocío, Seville, Spain. ltallona@hotmail.com
L
L
Tallón Aguilar
G
G
Jiménez Riera
G
G
Suárez Artacho
L M
LM
Marín Gómez
J
J
Serrano Díaz-Canedo
M A
MA
Gómez Bravo
D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D011169:Portal Vein / Q000473:pathology*; D013164:Splenorenal Shunt, Surgical / Q000009:adverse effects*; D013927:Thrombosis / Q000209:etiology*