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Postshunt encephalopathy in liver transplanted children with portal vein thrombosis
P Tissières1, D Pariente, C Chardot
1Groupe de Transplantation Hépatique Pédiatrique, Assistance Publique, H pitaux de Paris, France.
Insights
Portosystemic shunting can cause acute encephalopathy in liver transplant recipients with portal vein thrombosis. This complication can be fatal, necessitating alternative treatments to restore liver graft blood flow.
Area of Science:
- Hepatology
- Transplantation Surgery
- Pediatric Gastroenterology
Background:
- Portal hypertension in liver transplant recipients with portal vein thrombosis (PVT) is often managed with surgical portosystemic shunting.
- PVT is a significant complication following liver transplantation, impacting graft function and patient outcomes.
Observation:
- Two pediatric liver transplant recipients with PVT developed acute encephalopathy after portosystemic shunt creation or preservation.
- One patient underwent a mesocaval H-type shunt, while the other had a spontaneous splenorenal shunt preserved.
Findings:
- Post-shunt encephalopathy occurred months to years after transplantation in both cases.
- One child succumbed to the complications of encephalopathy, highlighting a dismal outcome.
Implications:
- Portosystemic shunting carries a risk of severe neurological complications, including fatal encephalopathy, in pediatric liver transplant recipients with PVT.
- Alternative strategies that restore hepatopetal blood flow to the liver graft are crucial for managing PVT in this vulnerable population.
Background:
Surgical portosystemic shunting has been reported to alleviate successfully portal hypertension in liver transplanted recipients with portal vein thrombosis.
Methods:
We report two liver transplanted children with portal vein thrombosis who developed post-shunt acute encephalopathy. In one child, a mesocaval H-type shunt was created surgically because of bleeding related to Roux-en-Y loop varices at 3 months posttransplantation; in the other, a large spontaneous splenorenal shunt was discovered at the time of diagnosis of portal vein thrombosis on day 34 posttransplantation and was preserved.
Results:
Post-shunt encephalopathy developed 6 months and 2.7 years after transplantation, causing death in one child.
Conclusions:
This report illustrates the risk and the possible dismal outcome of post-shunt encephalopathy in liver transplanted children. Therapeutic procedures other than portosystemic shunting that will restore an hepatopetal portal flow to the liver graft should be considered in liver-transplanted children with portal vein thrombosis.