Emergency portacaval shunt for control of hemorrhage from a parenchymal fracture after adult-to-adult living donor liver transplantation

As more adults undergo transplantation with partial liver grafts, the uniqu e features of these segments and their clinical significance will become ap parent. A patient presented with life-threatening hemorrhage from an iatrog enic laceration to a right lobe graft 11 days after transplantation. The cr eation of a portacaval shunt effectively controlled the bleeding, allowing more elective replacement of the organ with another right lobe graft. The r egeneration process combined with increased portal blood flow and relative outflow limitation may have set the stage for this complication, Any disrup tion of the liver parenchyma during transplantation should be securely repa ired and followed cautiously. Portacaval shunting is an option for controll ing hemorrhage from the liver in transplant recipients. The timely availabi lity of a second organ was likely the ultimate determinant of survival for this patient.