Portosystemic Shunts for "Too Small-for-Size Syndrome" After Liver Transplantation: A Systematic Review

Abstract

Background: Portosystemic shunts (PSSs) modulate the portal hyperperfusion against small-for-size syndrome (SFSS) after split or living donor liver transplantation.

Aim: To find out the results and the limitations of PSSs against SFSS.

Materials and methods: We searched PubMed and Cochrane databanks for systematic review and analyzed the indications, types, morbidities, and survivals of the PSSs at split or living donor liver transplantations.

Results: Total 66 patients were assessed in 16 studies. Main indications for PSS were graft recipient weight ratio (GRWRs) <0.8 % and/or portal vein pressure >20 mmHg. Five different types of PSSs were described but hemi-portocaval shunts were the most common one. The incidence of SFSS was 12 %. Overall 90-day, 1-, and 3-year graft survivals were 80, 70, and 47 %, respectively. GRWR <0.65 % was found as the only significant parameter on graft survival. The 90-day, 1- and 3-year graft survivals for GRWR <0.65 and ≥0.65 % patients were 62.5, 42.8, and 30.0 and 95, 94, and 67 %, respectively (p = 0.03, p = 0.01, and p = 0.18).

Conclusion: PSSs can modulate the small graft size (GRWR < 0.8 %) and/or portal hypertension (>20 mmHg) after split or living donor liver transplantations sufficiently. However, its protective effect is not unlimited. If the GRWR is below 0.65 %, survival decreases significantly despite PSSs.