Method for Spontaneous Constriction and Closure of Portocaval Shunt Using a Ligamentum Teres Hepatis in Small-for-Size Graft Liver Transplantation

Abstract

We have developed a new portocaval (PC) shunt creation technique for use in small-for-size (SFS) graft liver transplantations. PC shunts are already used to avoid SFS graft syndrome in cases of adult-to-adult living donor liver transplantation (LDLT), but the current method of creating these shunts is subject to two problems: reportal hypertension and liver dysfunction after premature ligation of the PC shunt; and graft atrophy and liver dysfunction because of the loss of portal venous flow late in the recovery period after LDLT. Our new technique avoids these two problems simultaneously by using the interposed obliterated ligamentum teres hepatis (LTH) to create the PC shunt, then obstructing the PC shunt after regeneration of the liver graft. We have used this technique in four cases. In all cases, portal venous pressures after shunting were lower than those before shunting, and PC shunts with lower portal pressure were obstructed faster than that with higher portal pressure. Our results suggest that the LTH can function as a shape memory graft to reduce portal venous flow after regeneration of the graft liver. Using the LTH to create a PC shunt might help to prevent both SFS graft syndrome early in the recovery period after LDLT and loss of portal venous flow late in the recovery period.