Adult Left Liver Transplantation With Mesocaval Shunt With Porto-Mesenteric Disconnection: Long-Term Outcome

Area of Science:

• Hepatology
• Transplantation Surgery
• Vascular Surgery

Background:

• Partial liver grafts in liver transplantation (LT) risk small-for-size syndrome and elevated portal venous pressure.
• Surgical techniques modulating portal venous inflow are explored to mitigate these risks.
• Mesenteric-caval shunt (MCS) with porto-mesenteric disconnection (PMD) is one such proposed technique.

Purpose of the Study:

• To evaluate the long-term outcomes of adult left split liver transplantation (SLT) utilizing MCS with PMD.
• To assess the efficacy and potential complications of this portal vein inflow modulation technique.

Main Methods:

• Retrospective analysis of 33 adult patients undergoing SLT between March 1996 and March 2010.
• MCS with PMD was performed in 10 cases for portal vein inflow modulation.
• Focus on 6 surviving patients who received a left split graft and underwent MCS with PMD.

Main Results:

• MCS with PMD successfully decreased mean portal vein pressure to 14.2 mmHg.
• Four out of six patients (4/6) who received MCS developed hyperammonemic encephalopathy late after LT (mean 9.1 years).
• Hyperammonemic encephalopathy was managed symptomatically with lactulose ± rifaximin, except for one patient requiring shunt closure.

Conclusions:

• Portal vein inflow modulation via MCS during LT can effectively reduce portal pressure.
• A significant complication is the potential for late-onset hyperammonemic encephalopathy.
• Careful patient selection and long-term monitoring are crucial for patients undergoing this procedure.