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Long-term outcome of liver transplantation for congenital extrahepatic portosystemic shunt.

We read with great interest the report by Uchida et al on the long-term outcomes of liver transplantation for congenital porto-systemic shunts (CPSS). We are in full agreement with the authors that there is an era effect in this report as we now know that most of the indications for liver transplantation in this series can be corrected by endovascular or surgical closure: hyperammonemia, hepatopulmonary syndrome, non-malignant nodules. The other notable feature of this report is the young age of patients at transplant with 19/26 patients having undergone transplantation before the age of 9 years, and 14/26 before the age of 5 years, of which two were for portopulmonary hypertension (POPH).