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Tomoaki Kato, MD; David M. Levi, MD; Wirviston DeFaria, MD; Seigo Nishida, MD; Andreas G. Tzakis, MD

Arch Surg. 2000;135:1401-1404.

Background  The distal splenorenal shunt (DSRS) is designed to maintain hepatopetal portal vein flow while decompressing gastroesophageal varices. However, over time, as the underlying liver disease progresses, the DSRS loses its selectivity. The most common method of addressing this issue during orthotopic liver transplantation is shunt ligation with or without splenectomy. Dismantling the shunt increases the complexity of the transplantation, and splenectomy may increase the risk of infection.

Hypothesis  Anastomosis of the donor portal vein to the left renal vein without dismantling the shunt is an effective method of portal vein reconstruction for patients with a patent DSRS.

Design  Retrospective analysis.

Setting  University-based teaching hospital, Miami, Fla.

Patients  Five liver transplant recipients with patent DSRS who received an orthotopic liver transplant between September 1996 and August 1999.

Interventions  The donor portal vein was anastomosed end-to-end to the left renal vein during liver transplantation.

Main Outcome Measures  Perioperatve morbidity, portal vein flow by Doppler study, patient survival, and graft survival.

Results  In all patients, the graft liver reperfused promptly via flow through the left renal vein with adequate decompression of the bowel. Normal portal venous flow was demonstrated by intraoperative and postoperative Doppler ultrasound studies. At the mean follow-up of 16 months, 4 patients were alive with well-functioning grafts.

Conclusions  This novel technique has the advantage of decreasing the complexity of the procedure, without requiring splenectomy, while securing adequate portal perfusion. Additionally, it can be applied without modifications in patients with portal vein thrombosis.

From the Division of Transplantation, University of Miami School of Medicine, Miami, Fla.

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Liver Transplantation With Renoportal Anastomosis After Distal Splenorenal Shunt—Invited Critique
J. Michael Henderson
Arch Surg. 2000;135(12):1404.
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