Rex shunt for portal vein thrombosis after adult living donor liver transplantation.

Portal vein thrombosis (PVT) after liver transplantation is a relatively common but serious complication which could lead to portal hypertension or a direct graft loss. A "Rex" shunt created between the superior mesenteric vein (SMV) and the umbilical portion of the left portal vein can be a useful option to treat PVT after pediatric liver transplantation, however, its application to adult patients has not been reported so far because appropriate vein grafts are hardly available. Herein we present a case of PVT after left lobe living donor liver transplantation (LDLT) who underwent the procedure using the own inferior jugular vein and the gonadal vein as a shunt graft. The shunt was patent immediately after the procedure but was thrombosed 2 days after probably due to the insufficient inflow from the SMV and the absence of anticoagulation therapy, for which emergent thrombectomy and ligation of the significant hepatofugal collateral veins followed by full anti-coagulation therapy were performed. The shunt remains open at 8 month after the procedure with a normal anmonia level and liver function. In conclusion, the Rex shunt using recipient's autologous vein grafts is a feasible and valuable option for adult patients to treat PVT after LDLT.