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 language | English |
|---|---|
| Pages (from-to) | 111-116 |
| Number of pages | 6 |
| Journal | American Journal of Surgery |
| Volume | 160 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 1990 |
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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 journal › Article
}
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 -