Posttransplantation Portal Thrombosis Secondary to Splenorenal Shunt Persistence

Aguilar, L Tallón; Riera, Gerónima; Artacho, G. Suárez; Gómez, Lourdes; Díaz-Canedo, J. Serrano; Bravo, Miguel Ángel Gómez

doi:10.1016/j.transproceed.2010.05.075

Cited by 20 publications

(16 citation statements)

References 3 publications

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“…Although the present study did not confirm the risk on early graft function, there was a significantly higher risk of encephalopathy and a trend toward more post‐LT PVT in the nonligated shunt group. This is in line with some previous reports . One can postulate that, if the incidence of complications known to exacerbate portal hypertension, such as outflow block or rejection, had occurred in our series, the latter risk of post‐LT PVT could have reached statistical significance (Table ).…”

Section: Discussionsupporting

confidence: 93%

“…In addition, access to, and ligation of SPSS may be technically challenging and associated with massive bleeding in the setting of severe portal hypertension in a patient with cirrhosis and could sometimes also lead to inferior vena cava (IVC) thrombosis . On the other hand, the outcomes of preservation of SPSSs following graft reperfusion have been poorly explored …”

mentioning

confidence: 99%

“…(11) On the other hand, the outcomes of preservation of SPSSs following graft reperfusion have been poorly explored. (3,12) A large series of consecutive cases of SPSSs managed according to a prospective management algorithm is analyzed here to assess whether SPSS ligation or not achieves similar short-term and longterm outcomes when both options to ligate the shunt or not are available.…”

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confidence: 99%

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Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: Audit of a prospective series of 66 consecutive patients

et al. 2018

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The management of large spontaneous portosystemic shunt (SPSS) during liver transplantation (LT) is a matter of debate. The aim of this study is to compare the short-term and longterm outcomes of SPSS ligation versus nonligation during LT, when both options are available. From 2011 to 2017, 66 patients with SPSS underwent LT: 56 without and 10 with portal vein thrombosis (PVT), all of whom underwent successful thrombectomy and could have portoportal reconstruction. The SPSS were either splenorenal (n = 40; 60.6%), left gastric (n = 16; 24.2%), or mesenterico-iliac (n = 10; 15.1%). Following portoportal anastomosis, the SPSS was ligated in 36 (54.4%) patients and left in place in 30 (45.5%) patients, based on the effect of the SPSS clamping/unclamping test on portal vein flow during the anhepatic phase. Intraoperatively, satisfactory portal flow was obtained in both groups. Primary nonfunction (PNF) and primary dysfunction (PDF) rates did not differ significantly between the 2 groups. Nonligation of SPSS was significantly associated with a higher rate of postoperative encephalopathy (P < 0.001) and major postoperative morbidity (P = 0.02). PVT occurred in 0 and 3 patients in the ligated and nonligated shunt group, respectively (P = 0.08). A composite end point, which included the relevant complications in the setting of SPSS in LT (ie, PNF and PDF, PVT, and encephalopathy) was present in 16 (44.4%) and 22 (73.3%) patients of the ligated and nonligated shunt group, respectively (P = 0.02). Patient (P = 0.05) and graft (P = 0.02) survival rates were better in the ligated shunt group. In conclusion, the present study supports routine ligation of large SPSS during LT whenever feasible. Liver Transplantation 24 505-515 2018 AASLD.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

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confidence: 99%

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Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: Audit of a prospective series of 66 consecutive patients

et al. 2018

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“…Other diagnostic tests that have been used to document SSRS include MRI, single photon emission CT 67. It is important to screen liver transplant patients for the presence of spontaneous porto-systemic shunts in order to increase the chance of graft survival and reduce the risk of post-transplant portal vein thrombosis, as the presence of these shunts decreases portal blood flow 72–74…”

Section: Spontaneous Splenorenal Shuntmentioning

confidence: 99%

Vascular Diseases of the Spleen: A Review

Francisco

Trivedi

et al. 2017

Journal of Clinical and Translational Hepatology

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Vascular diseases of the spleen are relatively uncommon in the clinical practice. However, the reported incidence has been progressively increasing, probably due to advances in the imaging modalities used to detect them. This disease condition often presents with non-specific clinical manifestations, but can be associated with significant morbidity and mortality. This review article aims to provide updated clinical information on the different vascular diseases of the splenic vasculature—splenic vein thrombosis, splenic vein aneurysm, splenic artery aneurysm, splenic arteriovenous fistula, and spontaneous splenorenal shunt—in order to aid clinicians in early diagnosis and management.

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“… found PV flow <15 cm/s to be associated with the development of PVT. This report was limited by a low event rate of PVT, no control arm, statistical imprecision reflected by exceedingly large confidence intervals, exclusion of high‐risk patients with inherited thrombophilia, and no adjustment for portosystemic shunting . In this investigation, we performed a matched case‐control study examining the primary hypothesis that PV flow is inversely associated with the development of PVT.…”

Section: Introductionmentioning

confidence: 99%

Decreased portal vein velocity is predictive of the development of portal vein thrombosis: A matched case‐control study

Stine

Wang

Shah

et al. 2017

Liver International

126

102

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Posttransplantation Portal Thrombosis Secondary to Splenorenal Shunt Persistence

Cited by 20 publications

References 3 publications

Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: Audit of a prospective series of 66 consecutive patients

Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: Audit of a prospective series of 66 consecutive patients

Vascular Diseases of the Spleen: A Review

Decreased portal vein velocity is predictive of the development of portal vein thrombosis: A matched case‐control study

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