Kokai H, Sato Y, Yamamoto S, Oya H, Nakatsuka H, Kobayashi T, Watanabe T, Takizawa K, Hatakeyama K
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, I-754 Asahimachi-Dori, Niigata 951-8510, Japan.
Transplant Proc. 2009 Dec;41(10):4259-61. doi: 10.1016/j.transproceed.2009.08.055.
We performed a living donor liver transplantation (LDLT) for a 57-year-old man who had end-stage liver failure with portal hypertension and an inferior mesenteric vein-left testicular vein (IMV-LTV) shunt. At operation, we did not clamp the shunt but encircled it with a coronary artery bypass graft (CABG) occluder (Sumitomo Bakelite K.K., Japan), which was passed outside the body through the abdominal wall to time-lag ligation (TLL). On postoperative day (POD) 5, we observed decreased portal flow. We performed TLL of the shunt using the CABG occluder without re-laparotomy. The portal flow increased, while the portal vein pressure increased slightly. In LDLT, portosystemic shunt has been reported to be a cause of portal thrombus formation or graft liver atrophy due to decreased PV flow in the mid postoperative period. However, perioperative ligation of a portosystemic shunt may prevent regeneration of the grafted liver because of excessive portal hypertension. Therefore the technique of time-lag ligation of a portosystemic shunt using a CABG occluder may be a minimally invasive, useful method to achieve physiological liver graft regeneration.
