Renoportal Anastomosis in Living Donor Liver Transplantation; An Effective Technique for Patient with Diffuse Portal Vein Thrombosis and Large Splenorenal Shunts

End-stage liver disease is often accompanied by portal vein thrombosis (PVT) and large spontaneous splenorenal shunts (SRS). Recently, renoportal anastomosis (RP-A) of spontaneous splenorenal shunts in liver transplantation was reported as an effective method of portal vein reconstruction in cases of PVT with SRS. Here we report a successful case of RP-A in living donor liver transplantation (LDLT). A 46-year-old female with a large spontaneous splenorenal shunt and a portal vein thrombosis propagated to the superior mesenteric vein underwent living donor liver transplantation. At the operation, a side-to-end renoportal anastomosis was done using an interposing cadaveric iliac vein graft. Adequate portal venous blood flow was demonstrated by intraoperative and postoperative Doppler ultrasound studies. She has recovered well with normal graft function and renal function. Renoportal anastomosis for patients with large splenorenal shunts and expansive portal vein thrombosis to the superior mesenteric vein can be an effective and safe technique in patients PV thrombectomy.

Living-Donor Liver Transplantation with Renoportal Anastomosis using an Interposition Polytetrafluoroethylene Graft for a Patient with Large Spontaneous Splenorenal Shunt: A Case Report / 대한이식학회지

Adequate portal perfusion is essential in liver transplantation. End-stage liver disease is often accompanied by a large spontaneous splenorenal shunt and poor portal flow. To secure an adequate portal perfusion of the graft, collaterals including splenorenal shunt should be interrupted during liver transplantation. However, this procedure is usually too demanding because of massive bleeding, as well as time-consuming. As in living-donor liver transplantation size-matched liver graft and vascular grafts are not always available, an alternative must be sought. We performed living-donor liver transplantation with renoportal anastomosis in a 52 year-old male with a large spontaneous splenorenal shunt. During surgery, left renal vein was divided at the caval junction and the distal stump was end-to-end anastomosed to the graft portal vein using 16 mm interposition polytetrafluoroethylene graft without ligation of collaterals. The initial postoperative course of this patient was uneventful. However, on postoperative day 6 and 12 perihepatic hematoma evacuation and portal vein graft thrombectomy were performed respectively. Since then, adequate portal blood flow and patency of the interposition polytetrafluoroethylene graft was maintained throughout the postoperative period. The patient was discharged with normal graft function 10 weeks after transplantation. Renoportal anastomosis using an interposition polytetrafluoroethylene graft in living-donor liver transplantation could be an acceptable alternative for patients with end-stage liver disease with a large spontaneous splenorenal shunt.

Usage of renoportal anastomosis in the liver transplantation / 中华器官移植杂志

Objective To evaluate the usage of renoportal anastomosis in the liver transplanta- tion.Method The successful experience about renoportal anastomosis for portal vein reconstruction in liver transplantation was reported,and related literature reviewed.Results Including our case,there have been 13 cases of liver transplantation using renoportal anastomosis for portal vein reconstruction. Among these patients,8 cases were complicated with diffuse portal vein thrombosis,and 10 cases had a splenorenal shunt(spontaneous shunt in 3 and surgical shunt in 7).Complications related to portal vein hypertension occurred in 3 cases(transient ascites in 2 cases and severe digestive bleeding in 1 case)after liver transplantation.There were 3 deaths which were not related to renoportal anastomo- sis.Conclusion Renoportal anastomosis is a safe and feasible technique in liver transplantation for the patients with diffuse portal vein thrombosis or with splenorenal shunt(spontaneous or surgical shunt).