ArticleJGH open : an open access journal of gastroenterology and hepatology2021
Endovascular management of portal steal syndrome due to portosystemic shunts after living donor liver transplantation.
Article in JGH open : an open access journal of gastroenterology and hepatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed, 5 citations in OpenAlex.
- EUS-guided coil placement and cyanoacrylate glue injection for gastric variceal bleeding with obvious spontaneous portosystemic shunts.Endoscopic ultrasoundArticle
- Imaging and Intervention in the Management of Vascular Complications Following Liver Transplantation.Journal of clinical and experimental hepatologyReview
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5 authors at 2 institutions in 1 country.
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Abstract
BACKGROUND AND
aimAfter liver transplant, pre-existent porto-systemic shunts (PSS) may persist, causing "portal steal," leading to graft dysfunction, hepatic encephalopathy (HE), and eventual rejection. In recipients of small-for-size transplant liver grafts, shunts may be created intraoperatively, facilitating diversion of portal flow to systemic circulation to avoid ill-effects of portal overperfusion. These iatrogenic shunts may also subsequently lead to portal steal. We aim to evaluate safety and efficacy of endovascular techniques in management of portal steal due to PSSs in living donor liver transplantation (LDLT) recipients.
methodsBetween 2013 and 2020, we encountered five LDLT recipients with large PSS, who presented with graft dysfunction and/or HE. One patient had a surgically created shunt and four had spontaneous shunts, not surgically ligated during transplant. Endovascular techniques including plug-assisted or balloon-occluded retrograde transvenous obliteration (PARTO/BRTO) or covered inferior vena cava (IVC) stent grafts were to occlude these PSS and counter the portal steal in all patients. Technical success and clinical outcomes at 1-year-follow-up were assessed.
resultsImaging showed large PSS causing portal steal syndrome in all five patients. IVC stent graft was used to isolate the shunt in two patients and PARTO/BARTO was performed in three patients. One patient had guarded prognosis due to multiple organ dysfunction and died 5 days after endovascular procedure. At 1-year follow up, graft functions normalized in four patients with no recurrence of HE. No procedure-related complications were seen.
conclusionEndovascular techniques can be safely and effectively used to counter portal steal syndrome in LDLT recipients, thus avoiding surgical re-exploration in these patients.
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