Spontaneous portosystemic shunt embolization in liver transplant recipients with recurrent hepatic encephalopathy.
Ann Hepatol 2022;
27:100687. [PMID:
35192963 DOI:
10.1016/j.aohep.2022.100687]
[Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES
Spontaneous portosystemic shunts (SPSS) are a common cause of recurrent hepatic encephalopathy (HE). Shunt occlusion is an effective and safe procedure when performed in patients with cirrhosis and preserved liver function. We aimed to describe our experience with SPSS embolization after liver transplantation (LT).
PATIENTS
We identified five patients who underwent SPSS embolization after LT. Clinical, biochemical and technical procedure data were collected.
RESULTS
At presentation, all patients had developed graft cirrhosis and HE after LT. Median Model for End-stage Liver Disease (MELD) at embolization was 9 (range 7-12), median Child-Pugh was 8 (range 7-9). Splenorenal and mesocaval shunt were the most frequent types of SPSS found. Three patients have been completely free of HE. Of the two patients who had HE recurrence after embolization, one patient had two episodes of HE which was controlled well with medications. The other patient required three embolizations because of recurrent HE. Median follow-up was 4.4 years (range 1.0-5.0) and MELD score at last follow up was 13 (range 10-18) and median Child-Pugh score B, 7 points (range 5-12).
CONCLUSIONS
SPSS can be considered as a cause of HE after LT. SPSS embolization is feasible and safe in LT recipients.
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