Pediatr Gastroenterol Hepatol Nutr.  2024 Jan;27(1):37-42. 10.5223/pghn.2024.27.1.37.

Outcomes of Portosystemic Shunts in Children with and without Liver Transplantation

• Khan HH
• Kaufman SS
• Yazigi NA
• Khan KM

• KMID: 2550857
• DOI: http://doi.org/10.5223/pghn.2024.27.1.37

Abstract

Purpose
Limited data exist regarding outcome and morbidity associated with portosystemic shunts in the pediatric transplant population. Our study assesses the outcomes of pediatric patients who underwent a portosystemic shunt procedure, both with and without liver transplantation (LT).
Methods
This study retrospectively reviewed the medical records of pediatric patients aged 0–19 years who underwent shunt placement between 2003 and 2017 at a tertiary care center. The analysis included cases of shunt placement with or without LT.
Results
A total of 13 pediatric patients were included in the study with median age of 8.8 years. Among the cases, 11 out of 13 (84.6%) underwent splenorenal shunt, 1 (7.7%) underwent a mesocaval shunt, and another 1 (7.7%) underwent a Modified Rex (mesoportal) shunt. Additionally, 5 out of 13 (38.5%) patients had LT, with 4 out of 5 (80.0%) receiving the transplant before shunt placement, and 1 out of 5 (20.0%) receiving it after shunt placement. Gastrointestinal bleeding resulting from portal hypertension was the indication in all cases. A total of 10 complications were reported in 5 patients; the most common complication was anemia in 3 (23.1%) patients. At the most recent follow-up visit, the shunts were functional without encephalopathy, and no deaths were reported.
Conclusion
Shunt placement plays a crucial role in the management of patients with portal hypertension. Our study demonstrates favorable long-term outcomes in pediatric patients who underwent shunt placement. Long term shunt outcomes were similar and unremarkable in patients with LT and without LT.

Keyword

Hypertension, portal; Liver transplantation; Thrombosis; Biliary atresia; Portosystemic shunt, surgical