Rex Shunt for Acute Portal Vein Thrombosis After Pediatric Liver Transplantation in Children With Biliary Atresia

• Published in: Transplantation proceedings Vol. 43; no. 1; pp. 194 - 195
• Main Authors: Gibelli, N.E.M, Tannuri, A.C.A, Tannuri, U, Santos, M.M, Pinho-Apezzato, M.L, Maksoud-Filho, J.G, Velhote, M.C.P, Ayoub, A.A.R, Silva, M.M, Andrade, W.C
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 2011; Elsevier
• Subjects: Acute Disease; Biliary Atresia - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Infant; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Portal Vein - pathology; Portal Vein - surgery; Portasystemic Shunt, Surgical; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thrombosis - surgery; Tissue, organ and graft immunology; Human; Biliary tract; Pediatrics; Biliary atresia; Shunt; Digestive system; Acute; Liver; Cardiovascular disease; Homotransplantation; Venous disease; Vascular disease; Medicine; Treatment; Surgery; Digestive diseases; Graft; Venous thrombosis; Portal vein; Child; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.11.011

Abstract Background/Purpose Posttransplantation portal vein thrombosis (PVT) can have severe health consequences, and portal hypertension and other consequences of the long-term privation of portal inflow to the graft may be hazardous, especially in young children. The Rex shunt has been used successfully to treat PVT patients since 1998. In 2007, we started to perform this surgery in patients with idiopathic PVT and late posttransplantation PVT. Herein we have reported our experience with this technique in acute posttransplantation PVT. Methods Three patients of ages 12, 15, and 18 months underwent cadaveric (n = 1) or living donor (n = 2) orthotopic liver transplantation (OLT). All patients had biliary atresia with portal vein hypoplasia; they developed acute PVT on the first postoperative day. They underwent a mesenteric-portal surgical shunt (Rex shunt) using a left internal jugular vein autograft (n = 2) or cadaveric iliac vein graft (n = 1) on the first postoperative day. Results The 8-month follow-up has confirmed shunt patency by postoperative Doppler ultrasound. There have been no biliary complications to date. Conclusions The mesenteric-portal shunt (Rex shunt) using an autograft of the left internal jugular or a cadaveric vein graft should be considered for children with acute PVT after OLT. These children usually have small portal veins; reanastomosis is often unsuccessful. In addition, this technique has the advantage to avoid manipulation of the hepatic hilum and biliary anastomosis. Although this study was based on a limited experience, we concluded that this technique is feasible, with great benefits to and low risks for these patients.