The most important news first: Annika is out of surgery and doing fine in the PICU. It was over 8 hours from the time they took her out of my arms until we spied her being wheeled out of the O.R. That's nearly as long as her first transplant, but nowhere close to the 12-hour marathon of her second.
Unfortunately, the Rex Shunt did not work for her. The surgeon came out after 4 hours and told us that every time they tried to move the bowel to get to her portal vein in her liver, she started bleeding like crazy.
The good news is that they were able to do a different kind of shunt, the spleno-renal shunt (also called a Warren shunt). I don't have time right now to google up some articles to link to, but the main difference is that the Rex Shunt would have restored blood flow (currently blocked by the clot) to her liver. The spleno-renal shunt instead redirects the blocked blood flow down toward her kidneys. This has the effect of instantly reducing the pressure that has been causing her to bleed from her esophagus. But it doesn't restore blood flow to the liver (and remember that the portal vein supplies some 80% of the liver's blood supply). Usually the spleno-renal shunt is done as a stop-gap measure to deal with bleeding varices for a patient who is waiting for a liver transplant. Obviously, we don't want to be waiting for a liver transplant (again). However, the surgeon said that she has developed her own new blood vessels which are sending blood to her liver, and her liver looks really good. So we're hopeful that this shunt might do the trick for her, even though it wasn't the shunt the doctors hoped to perform. Dr. Superina (her surgeon) sounded very upbeat, and that really does mean a lot to us.
There will be a lot going on in the next few days, but right now I'm looking forward to just seeing her beautiful eyes open back up again. Perhaps tomorrow, if all goes well.