Liver transplantation in patients with previous portasystemic shunt

Vincenzo Mazzaferro, Satoru Todo, Andreas G. Tzakis, Andrei C. Stieber, Leonard Makowka, Thomas E. Starzl

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Over a 9-year period, 58 patients who had previous portasystemic shunt procedures underwent orthotopic liver transplantation (OLTx) under a cyclosporine-steroid immunosuppressive regimen. The types of shunt used were distal splenorenal (18 patients), mesocaval (17 patients), end-to-side portacaval (11 patients), side-to-side portacaval (5 patients) and proximal splenorenal (7 patients). The mean interval between shunt and transplantation was 6 years. There was no statistical difference in survival between patients with previous shunts and the entire population of patients with primary liver transplantation performed during the same period of time. Age, sex, shunt patency, status of portal vein, and use of vein or artery graft did not affect survival. Child's classification had a significant influence on graft survival, even though no difference was subsequently observed in patient survival. A progressively improved intraoperative strategy and the use of veno-venous bypass and University of Wisconsin preservation solution had a significant impact on blood loss, length of operation, length of stay in intensive care unit, and ultimately, on survival. Distal splenorenal and mesocaval shunts with no or minimal hilum dissection are safer shunts if subsequent transplantation is planned; in fact, their 9-year survival was 87%, whereas all other shunts were associated with a survival no better than 52% (p

Original languageEnglish
Pages (from-to)111-116
Number of pages6
JournalAmerican Journal of Surgery
Volume160
Issue number1
DOIs
Publication statusPublished - 1990

Fingerprint

Surgical Portasystemic Shunt
Liver Transplantation
Survival
Transplantation
Surgical Splenorenal Shunt
Graft Survival
Immunosuppressive Agents
Portal Vein
Cyclosporine
Intensive Care Units
Dissection
Veins
Length of Stay
Arteries
Steroids
Transplants

ASJC Scopus subject areas

  • Surgery

Cite this

Liver transplantation in patients with previous portasystemic shunt. / Mazzaferro, Vincenzo; Todo, Satoru; Tzakis, Andreas G.; Stieber, Andrei C.; Makowka, Leonard; Starzl, Thomas E.

In: American Journal of Surgery, Vol. 160, No. 1, 1990, p. 111-116.

Research output: Contribution to journalArticle

Mazzaferro, V, Todo, S, Tzakis, AG, Stieber, AC, Makowka, L & Starzl, TE 1990, 'Liver transplantation in patients with previous portasystemic shunt', American Journal of Surgery, vol. 160, no. 1, pp. 111-116. https://doi.org/10.1016/S0002-9610(05)80879-7
Mazzaferro, Vincenzo ; Todo, Satoru ; Tzakis, Andreas G. ; Stieber, Andrei C. ; Makowka, Leonard ; Starzl, Thomas E. / Liver transplantation in patients with previous portasystemic shunt. In: American Journal of Surgery. 1990 ; Vol. 160, No. 1. pp. 111-116.
@article{cdc59b0066f24b86877a83e81970760e,
title = "Liver transplantation in patients with previous portasystemic shunt",
abstract = "Over a 9-year period, 58 patients who had previous portasystemic shunt procedures underwent orthotopic liver transplantation (OLTx) under a cyclosporine-steroid immunosuppressive regimen. The types of shunt used were distal splenorenal (18 patients), mesocaval (17 patients), end-to-side portacaval (11 patients), side-to-side portacaval (5 patients) and proximal splenorenal (7 patients). The mean interval between shunt and transplantation was 6 years. There was no statistical difference in survival between patients with previous shunts and the entire population of patients with primary liver transplantation performed during the same period of time. Age, sex, shunt patency, status of portal vein, and use of vein or artery graft did not affect survival. Child's classification had a significant influence on graft survival, even though no difference was subsequently observed in patient survival. A progressively improved intraoperative strategy and the use of veno-venous bypass and University of Wisconsin preservation solution had a significant impact on blood loss, length of operation, length of stay in intensive care unit, and ultimately, on survival. Distal splenorenal and mesocaval shunts with no or minimal hilum dissection are safer shunts if subsequent transplantation is planned; in fact, their 9-year survival was 87{\%}, whereas all other shunts were associated with a survival no better than 52{\%} (p",
author = "Vincenzo Mazzaferro and Satoru Todo and Tzakis, {Andreas G.} and Stieber, {Andrei C.} and Leonard Makowka and Starzl, {Thomas E.}",
year = "1990",
doi = "10.1016/S0002-9610(05)80879-7",
language = "English",
volume = "160",
pages = "111--116",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Liver transplantation in patients with previous portasystemic shunt

AU - Mazzaferro, Vincenzo

AU - Todo, Satoru

AU - Tzakis, Andreas G.

AU - Stieber, Andrei C.

AU - Makowka, Leonard

AU - Starzl, Thomas E.

PY - 1990

Y1 - 1990

N2 - Over a 9-year period, 58 patients who had previous portasystemic shunt procedures underwent orthotopic liver transplantation (OLTx) under a cyclosporine-steroid immunosuppressive regimen. The types of shunt used were distal splenorenal (18 patients), mesocaval (17 patients), end-to-side portacaval (11 patients), side-to-side portacaval (5 patients) and proximal splenorenal (7 patients). The mean interval between shunt and transplantation was 6 years. There was no statistical difference in survival between patients with previous shunts and the entire population of patients with primary liver transplantation performed during the same period of time. Age, sex, shunt patency, status of portal vein, and use of vein or artery graft did not affect survival. Child's classification had a significant influence on graft survival, even though no difference was subsequently observed in patient survival. A progressively improved intraoperative strategy and the use of veno-venous bypass and University of Wisconsin preservation solution had a significant impact on blood loss, length of operation, length of stay in intensive care unit, and ultimately, on survival. Distal splenorenal and mesocaval shunts with no or minimal hilum dissection are safer shunts if subsequent transplantation is planned; in fact, their 9-year survival was 87%, whereas all other shunts were associated with a survival no better than 52% (p

AB - Over a 9-year period, 58 patients who had previous portasystemic shunt procedures underwent orthotopic liver transplantation (OLTx) under a cyclosporine-steroid immunosuppressive regimen. The types of shunt used were distal splenorenal (18 patients), mesocaval (17 patients), end-to-side portacaval (11 patients), side-to-side portacaval (5 patients) and proximal splenorenal (7 patients). The mean interval between shunt and transplantation was 6 years. There was no statistical difference in survival between patients with previous shunts and the entire population of patients with primary liver transplantation performed during the same period of time. Age, sex, shunt patency, status of portal vein, and use of vein or artery graft did not affect survival. Child's classification had a significant influence on graft survival, even though no difference was subsequently observed in patient survival. A progressively improved intraoperative strategy and the use of veno-venous bypass and University of Wisconsin preservation solution had a significant impact on blood loss, length of operation, length of stay in intensive care unit, and ultimately, on survival. Distal splenorenal and mesocaval shunts with no or minimal hilum dissection are safer shunts if subsequent transplantation is planned; in fact, their 9-year survival was 87%, whereas all other shunts were associated with a survival no better than 52% (p

UR - http://www.scopus.com/inward/record.url?scp=0025345743&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025345743&partnerID=8YFLogxK

U2 - 10.1016/S0002-9610(05)80879-7

DO - 10.1016/S0002-9610(05)80879-7

M3 - Article

C2 - 2368871

AN - SCOPUS:0025345743

VL - 160

SP - 111

EP - 116

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 1

ER -