Postshunt encephalopathy in liver transplanted children with portal vein thrombosis

Background. Surgical portosystemic shunting has been reported to alleviate successfully portal hypertension in liver transplanted recipients with port al vein thrombosis. Methods. We report two liver transplanted children with portal vein thrombo sis who developed post-shunt acute encephalopathy. In one child, a mesocava l H-type shunt was created surgically because of bleeding related to Roux-e n-Y loop varices at 3 months posttransplantation; in the other, a large spo ntaneous splenorenal shunt was discovered at the time of diagnosis of porta l vein thrombosis on day 34 posttransplantation and was preserved. Results. Post-shunt encephalopathy developed 6 months and 2.7 years after t ransplantation, causing death in one child. Conclusions. This report illustrates the risk and the possible dismal outco me of post-shunt encephalopathy in liver transplanted children. Therapeutic procedures other than portosystemic shunting that will restore an hepatope tal portal flow to the liver graft should be considered in liver-transplant ed children with portal vein thrombosis.