Transplantation in Patients with Previous Portasystemic Shunt

Over a 9-yt'ar period, 58 patients who had pre"ious portasyslemic shunt procedures unden-ent orthotopic liver transplantation (OtTx) under a cyclosporine-steroid immunosuppresshe regimen. The types of shunt used were distal splenorenal (18 patients), mesocaval (17 patients). end-to-side portacaval (II patients). side-to-side portaca,'al (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 pre"ioU5 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 innuence on graft survival. even though no difference was subsequently observed in patient sun-ivaI. A progressively improved intraoperath'e strategy and the use of "eno-venous bypass and Unh-ersity of Wisconsin presen-ation 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 mesornal shunts with no or minimal hilum disieclion art' safer shunts if subsequent transplantation is planned:, in fact, their 9-year survival was 879{-. wbereas all other shunts were associated with a survival no belter than 529c (p <0.006).