title: Cavoportal hemitransposition for unrecognized spontaneous mesocaval shunt after liver transplantation: a case report.
abstract: Spontaneous portosystemic shunts can steal the blood away from the portal system. This may result in graft dysfunction or even loss following liver transplantation and can be sorted by shunt occlusion based on intraoperative flow measurements. Herein, we present an alternative technique with cavoportal hemitransposition performed for unrecognized spontaneous mesocaval shunt with 'portal steal' syndrome and primary graft nonfunction diagnosed first day following the transplant. This was chosen as a rescue strategy because an attempt to locate the shunt during relaparotomy was unsuccessful. As there was no improvement, emergency liver retransplantation with preservation of the cavoportal hemitransposition was performed on the fourth day after the primary transplant with good long-term outcome. We conclude that cavoportal hemitransposition during or after liver transplantation can be used to provide an adequate inflow into the donor portal vein if the shunting vessels responsible for the steal cannot be located and dealt with at surgery.
authors.affiliation: Department of General Surgery and Transplantation, M. Curie Hospital, Szczecin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Chmurowicz
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zasada-Cedro
authors.forename: Maciej
authors.initials: M
authors.lastname: Wojcicki
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D012086:Reoperation; D014682:Vena Cava, Inferior / Q000601:surgery*