title: Living-related liver transplantation with renoportal anastomosis for a patient with large spontaneous splenorenal collateral.
abstract: BACKGROUND
  A large splenorenal collateral must be interrupted during liver transplantation to secure adequate portal perfusion. However, this process increases the complexity of the operative procedure and may cause hazardous bleeding. Recently, renoportal anastomosis in portal reconstruction was reported in cadaveric liver transplantation for patients with surgically created splenorenal shunts. We used this technique in a living-related liver transplantation.
  
  
  METHODS
  A 29-year-old female with a large spontaneous splenorenal collateral and a portal venous thrombus underwent a living-related liver transplantation. At surgery, the left renal vein was divided and the distal stump was anastomosed to the portal vein of the graft without interrupting collaterals.
  
  
  RESULTS
  Adequate portal venous blood flow was maintained throughout the postoperative course. The patient was discharged 9 weeks after transplantation and remains well.
  
  
  CONCLUSIONS
  The renoportal anastomosis could be used for portal reconstruction in living-related liver transplantation for patients with a large splenorenal collateral. It provides adequate portal perfusion without interrupting collateral circulation.
authors.affiliation: Department of Surgery and Clinical Oncology, Osaka University Graduate School of Medicine, Suita-City, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyamoto
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
authors.forename: Keizo
authors.initials: K
authors.lastname: Dono
authors.forename: Koji
authors.initials: K
authors.lastname: Umeshita
authors.forename: Ryohei
authors.initials: R
authors.lastname: Kawabata
authors.forename: Shoho
authors.initials: S
authors.lastname: Hayashi
authors.forename: Masaru
authors.initials: M
authors.lastname: Kubota
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.forename: Shoji
authors.initials: S
authors.lastname: Nakamori
authors.forename: Masato
authors.initials: M
authors.lastname: Sakon
authors.forename: Morito
authors.initials: M
authors.lastname: Monden
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D011169:Portal Vein / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery*; D013154:Spleen / Q000098:blood supply*