Cystic fibrosis and portal hypertension: Distal splenorenal shunt can prevent the need for future liver transplant

Journal of Pediatric Surgery
Caroline LemoineR A Superina

Abstract

The management of portal hypertension (PHT) in children with well compensated cirrhosis and cystic fibrosis (CF) is controversial. We present our experience with distal splenorenal shunting (DSRS) for the treatment of PHT as an alternative to liver transplantation (LT). Between 2008 and 2017, 5 CF children underwent a DSRS at a pediatric hepatobiliary and transplantation referral center. LT (n = 9) was reserved for patients with decompensated cirrhosis. Statistical analysis was done using the paired t-test (p < 0.05 considered significant). Mean PELD/MELD score was significantly lower for DSRS patients than LT (3 ± 6 vs 28 ± 4, p < 0.001). All 5 DSRS patients had grade III-IV varices. One bled prior to surgery. After DSRS, spleen size decreased significantly from 8.4 ± 1.5 cm to 4.4 ± 1.8 cm (p = 0.019). Mean platelet count remained stable (87.8 ± 48 to 91.8 ± 35, p = 0.9). There were no postoperative complications. No DSRS patient experienced variceal bleeding following shunt creation. Liver function tests remained stable in the DSRS group, and no patient required a liver transplant (median follow up 4.65 years, range 1.24-7.79). Patients with cystic fibrosis who have well-compensated cirrhosis and symptomatic portal hypertens...Continue Reading

Citations

Feb 26, 2020·Current Opinion in Gastroenterology·Jeremy DanaDominique Debray
Nov 20, 2020·Pediatric Pulmonology·Adrienne P Savant, Susanna A McColley
Jun 7, 2021·Journal of Pediatric Gastroenterology and Nutrition·Gunter FlemmingEva-Doreen Pfister

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