Clinical Impact of Spontaenous Portosystemic Shunts on the Short Term Outcome of Liver Transplantation
1Transplant Hepatology, Mayo Clinic Arizona, Phoenix, AZ, 2Mayo Clinic School of Medicine, Mayo Clinic Arizona, Phoenix, AZ, 3Division of Health Sciences Research, Mayo Clinic Arizona, Phoenix, AZ, 4Radiology, Mayo Clinic Arizona, Phoenix, AZ, 5Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ
Meeting: 2019 American Transplant Congress
Abstract number: B300
Keywords: Graft failure, Liver grafts, Liver transplantation, Survival
Session Information
Date: Sunday, June 2, 2019
Session Name: Poster Session B: Liver Retransplantation and Other Complications
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: The aim of our study was to compare Liver Transplant (LT) candidates with and without spontaneous portosystemic shunts (SPSS) and assess their impact on patient mortality and graft survival in the post LT setting.
*Methods: Or institution transplanted 237 patients from 2013 to 2015. We analyzed patients who were 18 years or older and that had a CT or MRI of the abdomen prior to LT. Exclusion criteria included the presence of pre LT surgical portosystemic shunt, prior transplantation, indications that did not include cirrhosis and those who underwent combined organ transplantation. SPSS were classified in large or small size according to its maximum diameter, with a cut-off at 8mm by a radiology team. Multiple variables that could influence the post LT course were extracted for analysis. The overall survival and graft survival were estimated using Kaplan-Meier method and compared between groups using log-rank test.
*Results: We extracted data from 170 cirrhotic patients who underwent LT. After comparing patients with small or no SPSS vs those with large SPSS, no statistical difference was found for overall patient survival (HR 0.56, 0.19-1.67, p 0.29) and graft survival (HR 0.68, 0.28-1.69, p 0.40). Although no statistical significance was found when evaluating overall survival and graft survival when comparing if the graft used was from a donor deceased after cardiac death (DCD) vs deceased after brain death (DBD) ((HR 1.82, 0.7-4.73, p 0.21), (9/31 vs. 20/133, HR 1.91, 0.87-4.19, p 0.10) respectively), we can recognize that patients with DCD have a trend to have more post-transplant complications than those that received a DBD.
*Conclusions: This is the first study evaluating the clinical impact of SPSS in the post LT setting. The previously described association between SPSS and worse clinical outcomes in pre LT patients seems not to persist once patients undergo LT. Because the resolution of portal hypertension is not immediate and the presence of SPSS may impact the outcome in LT using DCD grafts, these findings can have significant implications. This is an ongoing study and we plan to present data at the meeting with an expanded sample size.
To cite this abstract in AMA style:
Rodriguez EA, Perez RM, Zhang N, Lim ES, Miller CR, Schwartz MA, McGirr AJ, Srinivasan A, Hewitt WR, Silva AC, Rakela J, Vargas HE. Clinical Impact of Spontaenous Portosystemic Shunts on the Short Term Outcome of Liver Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-impact-of-spontaenous-portosystemic-shunts-on-the-short-term-outcome-of-liver-transplantation/. Accessed February 27, 2021.« Back to 2019 American Transplant Congress