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Spontaneous meso-portal shunt following orthotopic liver transplantation in a child.

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Vannevel, Grégory [UCL] Clapuyt, Philippe [UCL] Reding, Raymond [UCL] Menten, Renaud [UCL]

Post-transplant children are regularly followed by colour Doppler US exam. Liver parenchyma, biliary tract and portal, subhepatic and arterial vascularisation are checked. We observed a post-transplant child with spontaneous meso-portal bypass after portal vein thrombosis (PVT). After orthotopic liver transplantation (OLT), PVT is frequently observed. When it occurs early (before 3 weeks), it has been identified as a cause of graft failure. On the other hand, late PVT (after 3 weeks) can be extremely well-tolerated, with cavernous transformation of the portal vein and formation of hepatopetal collaterals that deliver blood to the liver. However, extrahepatic portal hypertension (EHPH) and its related complications can develop. Cavernoma transformation is usually seen, but spontaneous shunt is not yet described in transplant patients. Distinction from the classic cavernoma can be achieved by the depiction of a single transcapsular vessel. This bypass partially corrects the EHPH. However it was decided to completely prevent shunt development by performing a surgical mesenterico-left portal vein bypass.

Document type Article de périodique (Journal article) – Journal Article
Access type Accès restreint
Publication date 2010
Journal information "Pediatric Radiology : roentgenology, nuclear medicine, ultrasonics, CT, MRI" - Vol. 40, no. suppl.1, p. 92-94 (2010)
Peer reviewed yes
Publisher Springer ((Germany) Heidelberg)
issn 0301-0449
e-issn 1432-1998
Publication status Publié
Affiliations UCL - (SLuc) Service de chirurgie et transplantation abdominale
UCL - (SLuc) Service de radiologie
UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation
UCL - SSS/IREC/IMAG - Pôle d'imagerie médicale
MESH Subject Mesenteric Veins - abnormalities - ultrasonography ; Liver Transplantation - adverse effects - ultrasonography ; Humans ; Hepatic Artery - abnormalities - ultrasonography ; Female ; Child ; Arteriovenous Fistula - etiology - ultrasonography
Links
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  2. Wozney P, Zajko AB, Bron KM, Point S, Starzl TE, Vascular complications after liver transplantation: a 5-year experience, 10.2214/ajr.147.4.657
  3. De Gaetano A M, Lafortune M, Patriquin H, De Franco A, Aubin B, Paradis K, Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic collateral circulation detected with Doppler sonography., 10.2214/ajr.165.5.7572494
  4. Vibert Éric, Azoulay Daniel, Castaing Denis, Bismuth Henri, Le cavernome portal : diagnostic, étiologies et conséquences, 10.1016/s0003-3944(02)00897-0
  5. Gauthier Frédéric, Recent concepts regarding extra-hepatic portal hypertension, 10.1053/j.sempedsurg.2005.06.004
  6. Zajko Albert B., Bron Klaus M., Hepatopetal collaterals after portal vein thrombosis following liver transplantation, 10.1007/bf02576985
  7. Bambini Daniel A., Superina Riccardo, Almond P.Stephen, Whitington Peter F., Alonso Estella, Experience with the Rex shunt (mesenterico-left portal bypass) in children with extrahepatic portal hypertension, 10.1016/s0022-3468(00)80005-6
  8. Dasgupta Roshni, Roberts Eve, Superina Riccardo A., Kim Peter C., Effectiveness of Rex shunt in the treatment of portal hypertension, 10.1016/j.jpedsurg.2005.10.059
Bibliographic reference Vannevel, Grégory ; Clapuyt, Philippe ; Reding, Raymond ; Menten, Renaud. Spontaneous meso-portal shunt following orthotopic liver transplantation in a child.. In: Pediatric Radiology : roentgenology, nuclear medicine, ultrasonics, CT, MRI, Vol. 40, no. suppl.1, p. 92-94 (2010)
Permanent URL http://hdl.handle.net/2078.1/32806