Use of distal splenorenal shunt in children referred for liver transplant evaluation

Thomas H. Renard, Walter S. Andrews, Nancy Rollins, R. Jeffery Zwiener, John Andersen, Satoru Shimaoka, Robert N. McClelland

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Variceal bleeding remains a common cause of morbidity for children with both intrahepatic and extrahepatic portal hypertension. Occasionally, patients referred for liver transplant evaluation have significant variceal bleeding, despite adequate synthetic liver function. During a 7-year period, 322 children were referred for liver transplant evaluation. Six underwent distal splenorenal shunt surgery after evaluation. There were four boys and two girls. The average age was 11 ± 4 years, and the average weight was 39 ± 15 kg. The etiology of variceal bleeding was intrahepatic portal hypertension in five (1 biliary atresia, 2 chronic hepatitis, 2 congenital hepatic fibrosis) and extrahepatic portal vein thrombosis in one. Two patients had no previous attempts at sclerotherapy (one because of an abnormality in platelet function, the other because of extensive gastric varices), and four had multiple previous sclerotherapy treatments. No patient had preoperative encephalopathy. Three cases were Child's class A, and three were Child's class B. Preoperative evaluation of the portasystemic system was performed with magnetic resonance (MR) imaging or splenoportography. All patients underwent a distal splenorenal shunt procedure, four of whom also had splenopancreatic disconnection. One patient required 100 mL of blood replacement, and five required no blood. The average length of hospital stay was 9.8 ± 2.2 days. Postoperative complications were minimal. All patients are alive, without recurrent gastrointestinal bleeding or encephalopathy, and they have patent shunts, which was confirmed by MR or Doppler ultrasound at a mean of 25 ± 20 months after shunt surgery. Children who have significant cirrhosis, portal hypertension, recurrent variceal bleeding refractory to sclerotherapy, and adequate synthetic function can be effectively treated with a distal splenorenal shunt. While the choice between liver transplantation of shunting may be difficult, use of the distal splenorenal shunt does not preclude future liver transplantation for such children.

Original languageEnglish (US)
Pages (from-to)403-406
Number of pages4
JournalJournal of Pediatric Surgery
Volume29
Issue number3
DOIs
StatePublished - 1994

Fingerprint

Surgical Splenorenal Shunt
Transplants
Sclerotherapy
Hemorrhage
Liver
Portal Hypertension
Brain Diseases
Liver Transplantation
Length of Stay
Portography
Biliary Atresia
Doppler Ultrasonography
Esophageal and Gastric Varices
Chronic Hepatitis
Portal Vein
Thrombosis
Fibrosis
Magnetic Resonance Spectroscopy
Blood Platelets
Magnetic Resonance Imaging

Keywords

  • liver transplant
  • Splenorenal shunt, distal

ASJC Scopus subject areas

  • Surgery

Cite this

Use of distal splenorenal shunt in children referred for liver transplant evaluation. / Renard, Thomas H.; Andrews, Walter S.; Rollins, Nancy; Zwiener, R. Jeffery; Andersen, John; Shimaoka, Satoru; McClelland, Robert N.

In: Journal of Pediatric Surgery, Vol. 29, No. 3, 1994, p. 403-406.

Research output: Contribution to journalArticle

Renard, Thomas H. ; Andrews, Walter S. ; Rollins, Nancy ; Zwiener, R. Jeffery ; Andersen, John ; Shimaoka, Satoru ; McClelland, Robert N. / Use of distal splenorenal shunt in children referred for liver transplant evaluation. In: Journal of Pediatric Surgery. 1994 ; Vol. 29, No. 3. pp. 403-406.
@article{dc0f8e68d7424bb7980e15082355f11e,
title = "Use of distal splenorenal shunt in children referred for liver transplant evaluation",
abstract = "Variceal bleeding remains a common cause of morbidity for children with both intrahepatic and extrahepatic portal hypertension. Occasionally, patients referred for liver transplant evaluation have significant variceal bleeding, despite adequate synthetic liver function. During a 7-year period, 322 children were referred for liver transplant evaluation. Six underwent distal splenorenal shunt surgery after evaluation. There were four boys and two girls. The average age was 11 ± 4 years, and the average weight was 39 ± 15 kg. The etiology of variceal bleeding was intrahepatic portal hypertension in five (1 biliary atresia, 2 chronic hepatitis, 2 congenital hepatic fibrosis) and extrahepatic portal vein thrombosis in one. Two patients had no previous attempts at sclerotherapy (one because of an abnormality in platelet function, the other because of extensive gastric varices), and four had multiple previous sclerotherapy treatments. No patient had preoperative encephalopathy. Three cases were Child's class A, and three were Child's class B. Preoperative evaluation of the portasystemic system was performed with magnetic resonance (MR) imaging or splenoportography. All patients underwent a distal splenorenal shunt procedure, four of whom also had splenopancreatic disconnection. One patient required 100 mL of blood replacement, and five required no blood. The average length of hospital stay was 9.8 ± 2.2 days. Postoperative complications were minimal. All patients are alive, without recurrent gastrointestinal bleeding or encephalopathy, and they have patent shunts, which was confirmed by MR or Doppler ultrasound at a mean of 25 ± 20 months after shunt surgery. Children who have significant cirrhosis, portal hypertension, recurrent variceal bleeding refractory to sclerotherapy, and adequate synthetic function can be effectively treated with a distal splenorenal shunt. While the choice between liver transplantation of shunting may be difficult, use of the distal splenorenal shunt does not preclude future liver transplantation for such children.",
keywords = "liver transplant, Splenorenal shunt, distal",
author = "Renard, {Thomas H.} and Andrews, {Walter S.} and Nancy Rollins and Zwiener, {R. Jeffery} and John Andersen and Satoru Shimaoka and McClelland, {Robert N.}",
year = "1994",
doi = "10.1016/0022-3468(94)90579-7",
language = "English (US)",
volume = "29",
pages = "403--406",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Use of distal splenorenal shunt in children referred for liver transplant evaluation

AU - Renard, Thomas H.

AU - Andrews, Walter S.

AU - Rollins, Nancy

AU - Zwiener, R. Jeffery

AU - Andersen, John

AU - Shimaoka, Satoru

AU - McClelland, Robert N.

PY - 1994

Y1 - 1994

N2 - Variceal bleeding remains a common cause of morbidity for children with both intrahepatic and extrahepatic portal hypertension. Occasionally, patients referred for liver transplant evaluation have significant variceal bleeding, despite adequate synthetic liver function. During a 7-year period, 322 children were referred for liver transplant evaluation. Six underwent distal splenorenal shunt surgery after evaluation. There were four boys and two girls. The average age was 11 ± 4 years, and the average weight was 39 ± 15 kg. The etiology of variceal bleeding was intrahepatic portal hypertension in five (1 biliary atresia, 2 chronic hepatitis, 2 congenital hepatic fibrosis) and extrahepatic portal vein thrombosis in one. Two patients had no previous attempts at sclerotherapy (one because of an abnormality in platelet function, the other because of extensive gastric varices), and four had multiple previous sclerotherapy treatments. No patient had preoperative encephalopathy. Three cases were Child's class A, and three were Child's class B. Preoperative evaluation of the portasystemic system was performed with magnetic resonance (MR) imaging or splenoportography. All patients underwent a distal splenorenal shunt procedure, four of whom also had splenopancreatic disconnection. One patient required 100 mL of blood replacement, and five required no blood. The average length of hospital stay was 9.8 ± 2.2 days. Postoperative complications were minimal. All patients are alive, without recurrent gastrointestinal bleeding or encephalopathy, and they have patent shunts, which was confirmed by MR or Doppler ultrasound at a mean of 25 ± 20 months after shunt surgery. Children who have significant cirrhosis, portal hypertension, recurrent variceal bleeding refractory to sclerotherapy, and adequate synthetic function can be effectively treated with a distal splenorenal shunt. While the choice between liver transplantation of shunting may be difficult, use of the distal splenorenal shunt does not preclude future liver transplantation for such children.

AB - Variceal bleeding remains a common cause of morbidity for children with both intrahepatic and extrahepatic portal hypertension. Occasionally, patients referred for liver transplant evaluation have significant variceal bleeding, despite adequate synthetic liver function. During a 7-year period, 322 children were referred for liver transplant evaluation. Six underwent distal splenorenal shunt surgery after evaluation. There were four boys and two girls. The average age was 11 ± 4 years, and the average weight was 39 ± 15 kg. The etiology of variceal bleeding was intrahepatic portal hypertension in five (1 biliary atresia, 2 chronic hepatitis, 2 congenital hepatic fibrosis) and extrahepatic portal vein thrombosis in one. Two patients had no previous attempts at sclerotherapy (one because of an abnormality in platelet function, the other because of extensive gastric varices), and four had multiple previous sclerotherapy treatments. No patient had preoperative encephalopathy. Three cases were Child's class A, and three were Child's class B. Preoperative evaluation of the portasystemic system was performed with magnetic resonance (MR) imaging or splenoportography. All patients underwent a distal splenorenal shunt procedure, four of whom also had splenopancreatic disconnection. One patient required 100 mL of blood replacement, and five required no blood. The average length of hospital stay was 9.8 ± 2.2 days. Postoperative complications were minimal. All patients are alive, without recurrent gastrointestinal bleeding or encephalopathy, and they have patent shunts, which was confirmed by MR or Doppler ultrasound at a mean of 25 ± 20 months after shunt surgery. Children who have significant cirrhosis, portal hypertension, recurrent variceal bleeding refractory to sclerotherapy, and adequate synthetic function can be effectively treated with a distal splenorenal shunt. While the choice between liver transplantation of shunting may be difficult, use of the distal splenorenal shunt does not preclude future liver transplantation for such children.

KW - liver transplant

KW - Splenorenal shunt, distal

UR - http://www.scopus.com/inward/record.url?scp=0028328570&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028328570&partnerID=8YFLogxK

U2 - 10.1016/0022-3468(94)90579-7

DO - 10.1016/0022-3468(94)90579-7

M3 - Article

C2 - 8201509

AN - SCOPUS:0028328570

VL - 29

SP - 403

EP - 406

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 3

ER -