Impact of posttransplant portosystemic shunts on liver transplantation.

Abstract

Posttransplant portosystemic shunts may result in severe fatty changes, portal vein complications, or graft liver failure because they reduce the effectiveness of portal perfusion through a portal steal phenomenon. However, the indications and timing of surgical and interventional treatments for posttransplant portosystemic shunts are still a matter of debate. We performed a retrospective investigation of the present state of long-term outpatients with posttransplant portosystemic shunts. This study comprised 150 outpatients who underwent liver transplantation between October 1988 and August 2006 in our department and other facilities. The diagnosis was based on the presence of any portosystemic shunts with the diameter of more than 5 mm indicated by computed tomography. A total of 16 patients (16/150, 10.7 %) were diagnosed as having posttransplant portosystemic shunt. Among them, eight patients (8/16, 50.0 %) developed portal vein complications, and 1 (1/16, 6.3 %) developed graft liver failure. The persistence of posttransplant portosystemic shunts results in portal vein complications or graft liver failure. Therefore, surgical and interventional treatment for patients with posttransplant portosystemic shunts should be performed based on the clinical and radiologic findings.