Impact of prior portosystemic shunt procedures on outcome of liver transplantation

Background. Cirrhotic patients may require portosystemic shunts as treatment for complications of portal hypertension. The aim of this study was to asses how these procedures may influence the orthotopic liver transplantation procedure and its outcome. Methods. Forty-five patients with a previous portosystemic shunt were divided into 3 groups (group 1, 19 with a portocaval shunt; group 2, 4 with a mesocaval shunt and 5 with a distal splenorenal shunts; group 3, 17 with a transjugular intrahepatic portosystemic shunt). Forty-five patients without a shunt, matched for age, gender, pretransplant liver status, and year of transplantation, were selected as controls. Surgical time, transfusional requirement, intensive care unit and total hospital duration of stay, complications, retransplantation rate, and short- and long-term mortality were analyzed. Results. Group 1 showed a significantly longer surgical time, higher red blood cell transfusional requirements, longer intensive care unit and hospital stay, and greater short and long-term mortality than the controls. No significant differences were observed between groups 2 and 3 and the controls. Conclusions. In cirrhotic patients, surgically created portosystemic shunts involving the hepatic hilum have a negative impact on liver transplantation. This operation should be avoided in potential liver transplant candidates; surgical shunts that do not compromise the hepatic hilum or transjugular intrahepatic portosystemic shunts are preferred.