Inferior mesenteric venous left renal vein shunting for decompression of excessive portal hypertension in adult living related liver transplantation.
In the present study, we investigated the effect of decompression of excessive portal hypertension by inferior mesenteric venous (IMV) left renal vein shunting in 7 cirrhotic patients with esophago-gastric varices and 2 patients who underwent adult living related donor liver transplantation (ALRDLT). The portal pressure remarkably decreased after shunting in all patients with esophago-gastric varices (388 +/- 42 mm H2O vs. 247 +/- 57 mm H2O; P < .05). It also decreased after a shunt operation in patients who had undergone liver transplantation. We report that the excessive shear stress by portal hypertension after small-for-size LRDLT induces a liver injury and the decompression of portal hypertension by splenic arterial ligation or splenectomy prevents postoperative liver injury following massive hepatectomy and small-for-size LRDLT. Our present studies suggested that IMV left renal vein shunting might prevent postoperative liver injury by partial decompression of excessive portal hypertension following small-for-size LRDLT.
Sato
Y
Y
Department of Regenerative and Transplant Medicine, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan. kanishok@med.niigata-u.ac.jp
Yamamoto
S
S
Takeishi
T
T
Kato
T
T
Nakatsuka
H
H
Kobayashi
T
T
Oya
H
H
Watanabe
T
T
Kokai
H
H
Hatakeyama
K
K
D000792:Angiography; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D012082:Renal Veins / Q000601:surgery*; D016896:Treatment Outcome