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

Abstract

Aiming to decrease portal venous pressure and to minimize the risk of small-for-size syndrome when using a partial liver graft for liver transplantation (LT), surgical techniques modulating venous portal inflow have been proposed. We report here our experience on the long-term outcome after adult left split LT with mesocaval shunt (MCS) with porto-mesenteric disconnection (PMD). Between March 1996 and March 2010, 33 adult patients underwent LT from a full-right/full-left SLT for two adult recipients; portal vein inflow modulation through a MCS with PMD was realized in 10 cases. The study population consisted of 13 left liver and 15 right liver recipients who survived more than 1 year without retransplantation. The technique of mesenterico-portal disconnection with MCS which allowed to decrease the mean portal vein pressure to 14.2 mm Hg, was applied in six recipients who survived more than 1 year without retransplantation: five males and one female, with a mean age of 60 years (range: 53–66) who all received a left split graft, with a mean weight and GRWR of 562 g (range: 430–740) and 0.79% (range: 0.61–0.98), respectively. During follow-up, four patients with MCS (4/6) experienced hyperammonemic encephalopathy, after a mean delay of 9.1 ± 7.9 years after LT (ranging 2.6–20.1). The outcome was favorable with symptomatic treatment with lactulose ± rifaximin in all cases except one, who underwent surgical closure of the shunt. In conclusion, our results emphasize that portal vein inflow modulation through MCS during LT can be complicated by late occurrence of hyperammonemic encephalopathy.