{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:56:43Z","timestamp":1790690203006,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although portal (venovenous) bypass (pVVB) is uncommon in liver transplantation (LT), it may provide some advantages, particularly for high\u2010acuity recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>To examine its use in high\u2010risk patients, we retrospectively evaluated outcomes of a modified pVVB technique among adult LT recipients at a single center, stratified by MELD score (\u226535 vs. &lt;35). Primary outcomes were patient and graft survival evaluated withKaplan\u2013Meier estimates and multivariable Cox regression; secondary outcomes included biliary complications, transfusion requirements, viscoelastic parameters, laboratory trends, length of stay, readmission, and need for dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between January 2016 and July 2025, 548 patients underwent LT with pVVB; 111 (20.3%) had MELD \u226535. Despite greater baseline severity, higher transfusion requirements, and longer postoperative ICU stay, MELD \u226535 was not associated with increased risk of graft failure (HR 1.19; 95% CI 0.72\u20131.96), mortality (HR 0.86; 95% CI 0.46\u20131.61), or biliary complications (HR 1.02; 95% CI 0.65\u20131.60). Post\u2010reperfusion viscoelastic measures were similar across groups. Dialysis was more frequent before and after LT in MELD \u226535. No complications or deaths were attributable to pVVB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among LT recipients treated with pVVB, MELD \u226535 was not significantly associated with graft failure, mortality, or biliary complications. These findings support the feasibility of pVVB in high\u2010acuity recipients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70703","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:05:53Z","timestamp":1790687153000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of a Modified Portal Venovenous Bypass Technique During Liver Transplantation in High\u2010MELD Recipients"],"prefix":"10.1111","volume":"40","author":[{"given":"Michael G.","family":"Megaly","sequence":"first","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C.","family":"Waller","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Health Data Science University of Minnesota School of Public Health  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Matthews","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Adams","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy L.","family":"Pruett","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Ramanathan","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja","family":"Kandaswamy","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik B.","family":"Finger","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Sutherland","sequence":"additional","affiliation":[{"name":"University of Minnesota Physicians  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Humphreville","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinath","family":"Chinnakotla","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2022.10108"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v7.i6.86"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2025.08.070"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.025520"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004211"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/13651820801953031"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1072\u20107515(02)01498\u20109"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/026765918700200108"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20102008\u20101040631"},{"issue":"3","key":"e_1_2_12_11_1","first-page":"270","article-title":"Veno\u2010Venous Bypass Without Systemic Anticoagulation for Transplantation of the Human Liver","volume":"160","author":"Griffith B. 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