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| Abstract |
Portal vein thrombosis (PVT) after liver transplantation is a relatively common but serious complication which could lead to portal hypertension or a direct graft loss. A “Rex” shunt created between t...he superior mesenteric vein (SMV) and the umbilical portion of the left portal vein can be a useful option to treat PVT after pediatric liver transplantation, however, its application to adult patients has not been reported so far because appropriate vein grafts are hardly available. Herein we present a case of PVT after left lobe living donor liver transplantation (LDLT) who underwent the procedure using the own inferior jugular vein and the gonadal vein as a shunt graft. The shunt was patent immediately after the procedure but was thrombosed 2 days after probably due to the insufficient inflow from the SMV and the absence of anticoagulation therapy, for which emergent thrombectomy and ligation of the significant hepatofugal collateral veins followed by full anti-coagulation therapy were performed. The shunt remains open at 8 month after the procedure with a normal anmonia level and liver function. In conclusion, the Rex shunt using recipient's autologous vein grafts is a feasible and valuable option for adult patients to treat PVT after LDLT.
肝移植後の門脈血栓症は比較的希な合併症であるが，門脈圧亢進症，グラフトロスにつながる重篤な合併症である．上腸間膜静脈と左門脈臍部間をバイパスするいわゆる「Rex シャント」は小児肝移植における門脈血栓に対する有用な治療オプションであるが，十分な長さのグラフトの確保が難しいため成人例における報告はいまだないのが現状である．本論文では，成人左葉生体肝移植後の門脈血栓症に対して，自身の内頸静脈と卵巣静脈をシャントグラフトとしてRex シャントを施行した一例を報告する．本シャントは術後2 日目に閉塞したが，緊急血栓摘出および抗凝固療法を施行により術後8ヶ月の時点において開存中である．自家静脈を用いたRex シャント術は，成人症例においても生体肝移植後の門脈血栓症の治療法として有用な治療オプションである．show more
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