Impact of temporary portocaval shunt during living-donor liver transplant

Soliman, Hosam E.M.; Hussien, Naglaa M.; Elkadi, Mohamed S.; Shoreem, Hany A.M.; Shady, Mohamed A.A.; Sallam, Ahmed N.

doi:10.4103/ejs.ejs_102_22

Impact of temporary portocaval shunt during living-donor liver transplant

Authors

Abstract

Background
Portal vein clamping is needed to facilitate hepatectomy; however, it causes intestinal congestion and damage and hemodynamic instability. Damage become more influenced after reperfusion. It affects both the intestine and the distant organs including the graft. In this study, we evaluated the effect of constructing temporary portocaval shunt (TPCS) during living-donor liver transplant.
Patients and methods
This study was designed as a prospective cohort study, which included 42 cases of living-donor liver transplant performed in the National Liver Institute. The study was conducted from 2018 to 2021. Patients were divided into two groups: group A included 20 patients with TPCS group and group B included 22 patients without TPCS (no-TPCS group).
Results
The procedure of TPCS required about 10.45 min to create, 4.5 min to close, and no major complications were encountered. TPCS was significantly associated with prolonged anhepatic phase (=0.001). There was decreased requirements of vasopressors (=0.003) and lower level of lactate on the day of operation (=0.001), alanine aminotransferase at first week (=0.027), and lower rate of infection (=0.047). There was no significant effect on the transfusion of blood products, postoperative gastrointestinal tract function and graft or patient survival.
Conclusion
Based on the results of this study, TPCS is a good choice in cases with difficult hepatectomy, or prolonged anhepatic phase provided no sufficient spontaneous distal portosystemic shunts.

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