Recurrent portal hypertension after composite liver/small bowel transplantation
Late technical complications of composite liver/small bowel transplantation procedures are often complex and have not been well defined. Here we describe the unusual presentation and management of two cases of recurrent thrombocytopenia due to hypersplenism resulting from portacaval shunt stenosis....
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| Veröffentlicht in: | Liver transplantation 2002-07, Vol.8 (7), p.639-642 |
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| container_title | Liver transplantation |
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| creator | Fishbein, Thomas M. Florman, Sander Gondolesi, Gabriel LeLeiko, Neal S. Mitty, Harold A. Tschernia, Allan Kaufman, Stuart S. |
| description | Late technical complications of composite liver/small bowel transplantation procedures are often complex and have not been well defined. Here we describe the unusual presentation and management of two cases of recurrent thrombocytopenia due to hypersplenism resulting from portacaval shunt stenosis. Both patients presented with portal hypertension late after composite liver/small bowel transplantation. One patient presented with recurrent bouts of upper gastrointestinal hemorrhage and was ultimately found to have a stenosis of her native portacaval shunt. After unsuccessful balloon dilatation of the anastomosis, a successful side-to-side distal splenorenal shunt was performed. The second patient presented with severe thrombocytopenia, the etiology of which was determined to be a short segment occlusion of the inferior vena cava between the native portacaval shunt and the piggyback outflow anastomosis of the liver graft. Total caval occlusion prevented balloon dilatation; the patient was relisted for transplantation but died of chronic rejection four months later. Recurrent portal hypertension is challenging in patients who have had combined liver/small bowel transplantation. Surgeons performing intestinal transplantation need to be increasingly aware of these possible late complications. (Liver Transpl 2002;8:639-642.) |
| doi_str_mv | 10.1053/jlts.2002.33455 |
| format | Article |
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Here we describe the unusual presentation and management of two cases of recurrent thrombocytopenia due to hypersplenism resulting from portacaval shunt stenosis. Both patients presented with portal hypertension late after composite liver/small bowel transplantation. One patient presented with recurrent bouts of upper gastrointestinal hemorrhage and was ultimately found to have a stenosis of her native portacaval shunt. After unsuccessful balloon dilatation of the anastomosis, a successful side-to-side distal splenorenal shunt was performed. The second patient presented with severe thrombocytopenia, the etiology of which was determined to be a short segment occlusion of the inferior vena cava between the native portacaval shunt and the piggyback outflow anastomosis of the liver graft. Total caval occlusion prevented balloon dilatation; the patient was relisted for transplantation but died of chronic rejection four months later. Recurrent portal hypertension is challenging in patients who have had combined liver/small bowel transplantation. Surgeons performing intestinal transplantation need to be increasingly aware of these possible late complications. (Liver Transpl 2002;8:639-642.)</description><identifier>ISSN: 1527-6465</identifier><identifier>EISSN: 1527-6473</identifier><identifier>DOI: 10.1053/jlts.2002.33455</identifier><identifier>PMID: 12089720</identifier><language>eng</language><publisher>Philadelphia, PA: Elsevier Inc</publisher><subject>Anastomosis, Surgical ; Fatal Outcome ; Female ; Gastrointestinal Hemorrhage - etiology ; Graft Rejection ; Humans ; Hypersplenism - etiology ; Hypertension, Portal - etiology ; Infant ; Intestines - blood supply ; Intestines - transplantation ; Liver Transplantation - adverse effects ; Liver Transplantation - methods ; Radiography ; Recurrence ; Splenorenal Shunt, Surgical ; Thrombocytopenia - etiology ; Varicose Veins - etiology ; Vascular Diseases - diagnostic imaging ; Vascular Diseases - etiology ; Vena Cava, Inferior</subject><ispartof>Liver transplantation, 2002-07, Vol.8 (7), p.639-642</ispartof><rights>2002 American Association for the Study of Liver Diseases</rights><rights>Copyright © 2002 American Association for the Study of Liver Diseases</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4333-d779ba4aa8d5e3fea5d4d0aceb77adac22bc14caf147fcb0d1d22c6fc1f1c0243</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1053%2Fjlts.2002.33455$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1053%2Fjlts.2002.33455$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12089720$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fishbein, Thomas M.</creatorcontrib><creatorcontrib>Florman, Sander</creatorcontrib><creatorcontrib>Gondolesi, Gabriel</creatorcontrib><creatorcontrib>LeLeiko, Neal S.</creatorcontrib><creatorcontrib>Mitty, Harold A.</creatorcontrib><creatorcontrib>Tschernia, Allan</creatorcontrib><creatorcontrib>Kaufman, Stuart S.</creatorcontrib><title>Recurrent portal hypertension after composite liver/small bowel transplantation</title><title>Liver transplantation</title><addtitle>Liver Transpl</addtitle><description>Late technical complications of composite liver/small bowel transplantation procedures are often complex and have not been well defined. Here we describe the unusual presentation and management of two cases of recurrent thrombocytopenia due to hypersplenism resulting from portacaval shunt stenosis. Both patients presented with portal hypertension late after composite liver/small bowel transplantation. One patient presented with recurrent bouts of upper gastrointestinal hemorrhage and was ultimately found to have a stenosis of her native portacaval shunt. After unsuccessful balloon dilatation of the anastomosis, a successful side-to-side distal splenorenal shunt was performed. The second patient presented with severe thrombocytopenia, the etiology of which was determined to be a short segment occlusion of the inferior vena cava between the native portacaval shunt and the piggyback outflow anastomosis of the liver graft. Total caval occlusion prevented balloon dilatation; the patient was relisted for transplantation but died of chronic rejection four months later. Recurrent portal hypertension is challenging in patients who have had combined liver/small bowel transplantation. Surgeons performing intestinal transplantation need to be increasingly aware of these possible late complications. (Liver Transpl 2002;8:639-642.)</description><subject>Anastomosis, Surgical</subject><subject>Fatal Outcome</subject><subject>Female</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Graft Rejection</subject><subject>Humans</subject><subject>Hypersplenism - etiology</subject><subject>Hypertension, Portal - etiology</subject><subject>Infant</subject><subject>Intestines - blood supply</subject><subject>Intestines - transplantation</subject><subject>Liver Transplantation - adverse effects</subject><subject>Liver Transplantation - methods</subject><subject>Radiography</subject><subject>Recurrence</subject><subject>Splenorenal Shunt, Surgical</subject><subject>Thrombocytopenia - etiology</subject><subject>Varicose Veins - etiology</subject><subject>Vascular Diseases - diagnostic imaging</subject><subject>Vascular Diseases - etiology</subject><subject>Vena Cava, Inferior</subject><issn>1527-6465</issn><issn>1527-6473</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkEtLAzEUhYMovtfuZFbu2t4kk8l0KeILCgXRdcgkdzCSmYxJqvTfO7VFV-Lq3sV3DoePkAsKUwqCz958TlMGwKacl0LskWMqmJxUpeT7P38ljshJSm8AlIo5HJIjyqCeSwbHZPmEZhUj9rkYQszaF6_rAWPGPrnQF7rNGAsTuiEkl7Hw7gPjLHXa-6IJn-iLHHWfBq_7rPOYOCMHrfYJz3f3lLzc3T7fPEwWy_vHm-vFxJSc84mVct7oUuvaCuQtamFLC9pgI6W22jDWGFoa3dJStqYBSy1jpmoNbakBVvJTcrXtHWJ4X2HKqnPJoB-HYFglJWldiUrIEZxtQRNDShFbNUTX6bhWFNTGodo4VBuH6tvhmLjcVa-aDu0vv5M2AvUW-HQe1__1qcWzAIAaJOVjdL6N4ujmw2FUyTjsDVoX0WRlg_tz1xceApUl</recordid><startdate>200207</startdate><enddate>200207</enddate><creator>Fishbein, Thomas M.</creator><creator>Florman, Sander</creator><creator>Gondolesi, Gabriel</creator><creator>LeLeiko, Neal S.</creator><creator>Mitty, Harold A.</creator><creator>Tschernia, Allan</creator><creator>Kaufman, Stuart S.</creator><general>Elsevier Inc</general><general>W.B. Saunders</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200207</creationdate><title>Recurrent portal hypertension after composite liver/small bowel transplantation</title><author>Fishbein, Thomas M. ; Florman, Sander ; Gondolesi, Gabriel ; LeLeiko, Neal S. ; Mitty, Harold A. ; Tschernia, Allan ; Kaufman, Stuart S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4333-d779ba4aa8d5e3fea5d4d0aceb77adac22bc14caf147fcb0d1d22c6fc1f1c0243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Anastomosis, Surgical</topic><topic>Fatal Outcome</topic><topic>Female</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Graft Rejection</topic><topic>Humans</topic><topic>Hypersplenism - etiology</topic><topic>Hypertension, Portal - etiology</topic><topic>Infant</topic><topic>Intestines - blood supply</topic><topic>Intestines - transplantation</topic><topic>Liver Transplantation - adverse effects</topic><topic>Liver Transplantation - methods</topic><topic>Radiography</topic><topic>Recurrence</topic><topic>Splenorenal Shunt, Surgical</topic><topic>Thrombocytopenia - etiology</topic><topic>Varicose Veins - etiology</topic><topic>Vascular Diseases - diagnostic imaging</topic><topic>Vascular Diseases - etiology</topic><topic>Vena Cava, Inferior</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fishbein, Thomas M.</creatorcontrib><creatorcontrib>Florman, Sander</creatorcontrib><creatorcontrib>Gondolesi, Gabriel</creatorcontrib><creatorcontrib>LeLeiko, Neal S.</creatorcontrib><creatorcontrib>Mitty, Harold A.</creatorcontrib><creatorcontrib>Tschernia, Allan</creatorcontrib><creatorcontrib>Kaufman, Stuart S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Liver transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fishbein, Thomas M.</au><au>Florman, Sander</au><au>Gondolesi, Gabriel</au><au>LeLeiko, Neal S.</au><au>Mitty, Harold A.</au><au>Tschernia, Allan</au><au>Kaufman, Stuart S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Recurrent portal hypertension after composite liver/small bowel transplantation</atitle><jtitle>Liver transplantation</jtitle><addtitle>Liver Transpl</addtitle><date>2002-07</date><risdate>2002</risdate><volume>8</volume><issue>7</issue><spage>639</spage><epage>642</epage><pages>639-642</pages><issn>1527-6465</issn><eissn>1527-6473</eissn><abstract>Late technical complications of composite liver/small bowel transplantation procedures are often complex and have not been well defined. Here we describe the unusual presentation and management of two cases of recurrent thrombocytopenia due to hypersplenism resulting from portacaval shunt stenosis. Both patients presented with portal hypertension late after composite liver/small bowel transplantation. One patient presented with recurrent bouts of upper gastrointestinal hemorrhage and was ultimately found to have a stenosis of her native portacaval shunt. After unsuccessful balloon dilatation of the anastomosis, a successful side-to-side distal splenorenal shunt was performed. The second patient presented with severe thrombocytopenia, the etiology of which was determined to be a short segment occlusion of the inferior vena cava between the native portacaval shunt and the piggyback outflow anastomosis of the liver graft. Total caval occlusion prevented balloon dilatation; the patient was relisted for transplantation but died of chronic rejection four months later. Recurrent portal hypertension is challenging in patients who have had combined liver/small bowel transplantation. Surgeons performing intestinal transplantation need to be increasingly aware of these possible late complications. (Liver Transpl 2002;8:639-642.)</abstract><cop>Philadelphia, PA</cop><pub>Elsevier Inc</pub><pmid>12089720</pmid><doi>10.1053/jlts.2002.33455</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Alma/SFX Local Collection |
| subjects | Anastomosis, Surgical Fatal Outcome Female Gastrointestinal Hemorrhage - etiology Graft Rejection Humans Hypersplenism - etiology Hypertension, Portal - etiology Infant Intestines - blood supply Intestines - transplantation Liver Transplantation - adverse effects Liver Transplantation - methods Radiography Recurrence Splenorenal Shunt, Surgical Thrombocytopenia - etiology Varicose Veins - etiology Vascular Diseases - diagnostic imaging Vascular Diseases - etiology Vena Cava, Inferior |
| title | Recurrent portal hypertension after composite liver/small bowel transplantation |
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