Method for spontaneous constriction and closure of portocaval shunt using a ligamentum teres hepatis in small-for-size graft liver transplantation.

Abstract

BACKGROUND We have developed a new portocaval (PC) shunt creation technique for use in small-for-size (SFS) graft liver transplantations. PC shunts are already used to avoid SFS graft syndrome in cases of adult-to-adult living donor liver transplantation (LDLT), but the current method of creating these shunts is subject to two problems: reportal hypertension and liver dysfunction after premature ligation of the PC shunt; and graft atrophy and liver dysfunction because of the loss of portal venous flow late in the recovery period after LDLT. METHODS Our new technique avoids these two problems simultaneously by using the interposed obliterated ligamentum teres hepatis (LTH) to create the PC shunt, then obstructing the PC shunt after regeneration of the liver graft. RESULTS We have used this technique in four cases. In all cases, portal venous pressures after shunting were lower than those before shunting, and PC shunts with lower portal pressure were obstructed faster than that with higher portal pressure. CONCLUSION Our results suggest that the LTH can function as a shape memory graft to reduce portal venous flow after regeneration of the graft liver. Using the LTH to create a PC shunt might help to prevent both SFS graft syndrome early in the recovery period after LDLT and loss of portal venous flow late in the recovery period.

DOI: 10.1097/TP.0b013e3181fa93e0

Statistics

010020020132014201520162017
Citations per Year

152 Citations

Semantic Scholar estimates that this publication has 152 citations based on the available data.

See our FAQ for additional information.

Cite this paper

@article{Sato2010MethodFS, title={Method for spontaneous constriction and closure of portocaval shunt using a ligamentum teres hepatis in small-for-size graft liver transplantation.}, author={Yoshinobu Sato and Hiroshi Oya and Satoshi Yamamoto and Takashi Kobayashi and Yoshiaki Hara and Hidenaka Kokai and Katsuyoshi Hatakeyama}, journal={Transplantation}, year={2010}, volume={90 11}, pages={1200-3} }