title: Rex shunt for acute portal vein thrombosis after pediatric liver transplantation in children with biliary atresia.
abstract: OBJECTIVE
  Posttransplantation portal vein thrombosis (PVT) can have severe health consequences, and portal hypertension and other consequences of the long-term privation of portal inflow to the graft may be hazardous, especially in young children. The Rex shunt has been used successfully to treat PVT patients since 1998. In 2007, we started to perform this surgery in patients with idiopathic PVT and late posttransplantation PVT. Herein we have reported our experience with this technique in acute posttransplantation PVT.
  
  
  METHODS
  Three patients of ages 12, 15, and 18 months underwent cadaveric (n = 1) or living donor (n = 2) orthotopic liver transplantation (OLT). All patients had biliary atresia with portal vein hypoplasia; they developed acute PVT on the first postoperative day. They underwent a mesenteric-portal surgical shunt (Rex shunt) using a left internal jugular vein autograft (n = 2) or cadaveric iliac vein graft (n = 1) on the first postoperative day.
  
  
  RESULTS
  The 8-month follow-up has confirmed shunt patency by postoperative Doppler ultrasound. There have been no biliary complications to date.
  
  
  CONCLUSIONS
  The mesenteric-portal shunt (Rex shunt) using an autograft of the left internal jugular or a cadaveric vein graft should be considered for children with acute PVT after OLT. These children usually have small portal veins; reanastomosis is often unsuccessful. In addition, this technique has the advantage to avoid manipulation of the hepatic hilum and biliary anastomosis. Although this study was based on a limited experience, we concluded that this technique is feasible, with great benefits to and low risks for these patients.
authors.affiliation: Department of Pediatrics, Pediatric Surgery and Liver Transplantation Division, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. nelson.gibelli@icr.usp.br
authors.forename: N E M
authors.initials: NE
authors.lastname: Gibelli
authors.forename: A C A
authors.initials: AC
authors.lastname: Tannuri
authors.forename: U
authors.initials: U
authors.lastname: Tannuri
authors.forename: M M
authors.initials: MM
authors.lastname: Santos
authors.forename: M L
authors.initials: ML
authors.lastname: Pinho-Apezzato
authors.forename: J G
authors.initials: JG
authors.lastname: Maksoud-Filho
authors.forename: M C P
authors.initials: MC
authors.lastname: Velhote
authors.forename: A A R
authors.initials: AA
authors.lastname: Ayoub
authors.forename: M M
authors.initials: MM
authors.lastname: Silva
authors.forename: W C
authors.initials: WC
authors.lastname: Andrade
mesh_terms: D000208:Acute Disease; D001656:Biliary Atresia / Q000601:surgery*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical; D013927:Thrombosis / Q000601:surgery*