Liver transplantation with renoportal anastomosis after distal splenorenal shunt

Tomoaki Kato, David M. Levi, Wirviston Defaria, Seigo Nishida, Andreas G. Tzakis

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1401-1404
Number of pages4
JournalArchives of Surgery
Volume135
Issue number12
StatePublished - Dec 27 2000

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Surgical Splenorenal Shunt
Portal Vein
Liver Transplantation
Renal Veins
Splenectomy
Transplants
Liver
Tissue Donors
Doppler Ultrasonography
Varicose Veins
Graft Survival
Decompression
Teaching Hospitals
Ligation
Liver Diseases
Thrombosis
Perfusion
Transplantation
Outcome Assessment (Health Care)
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Kato, T., Levi, D. M., Defaria, W., Nishida, S., & Tzakis, A. G. (2000). Liver transplantation with renoportal anastomosis after distal splenorenal shunt. Archives of Surgery, 135(12), 1401-1404.

Liver transplantation with renoportal anastomosis after distal splenorenal shunt. / Kato, Tomoaki; Levi, David M.; Defaria, Wirviston; Nishida, Seigo; Tzakis, Andreas G.

In: Archives of Surgery, Vol. 135, No. 12, 27.12.2000, p. 1401-1404.

Research output: Contribution to journalArticle

Kato, T, Levi, DM, Defaria, W, Nishida, S & Tzakis, AG 2000, 'Liver transplantation with renoportal anastomosis after distal splenorenal shunt', Archives of Surgery, vol. 135, no. 12, pp. 1401-1404.
Kato T, Levi DM, Defaria W, Nishida S, Tzakis AG. Liver transplantation with renoportal anastomosis after distal splenorenal shunt. Archives of Surgery. 2000 Dec 27;135(12):1401-1404.
Kato, Tomoaki ; Levi, David M. ; Defaria, Wirviston ; Nishida, Seigo ; Tzakis, Andreas G. / Liver transplantation with renoportal anastomosis after distal splenorenal shunt. In: Archives of Surgery. 2000 ; Vol. 135, No. 12. pp. 1401-1404.
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