Ligation of left renal vein for large spontaneous splenorenal shunt to prevent portal flow steal in adult living donor liver transplantation.
Persistance of a large spontaneous splenorenal shunt (SRS) may result in graft failure in adult living donor liver transplantation (LDLT) because it reduces the effective portal perfusion to the partial liver graft by diversion of hepatotrophic portal flow into this hepatofugal pathway. We performed a prospective study to evaluate the efficacy of ligation of left renal vein (LRV) to prevent portal flow steal and the safety of this procedure to the renal function in adult LDLT patients with SRS. Between October 2001 and January 2005, 44 cirrhotic patients with large SRS underwent LDLT with ligation of LRV. Each patient received pre- and postoperative computed tomography and Doppler USG to assess the changes of collaterals and portal flow, as well as serial renal and liver function tests. Portal flow after ligation of LRV was statistically and significantly increased when compared with pre-operative value (P = 0.001). Whereas four patients (9.1%) demonstrated sustained, elevated serum creatinine levels after operation, the renal function tests returned to normal in 40 patients. All patients recovered with satisfactory regeneration of the partial liver graft and there was no procedure-related permanent renal dysfunction. In conclusion, ligation of LRV to prevent a 'portal steal phenomenon' seems to be a safe and effective graft salvage procedure for large spontaneous SRS (>10-mm diameter) in adult LDLT.
Lee
Sung-Gyu
SG
Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sglee2@amc.seoul.kr
Moon
Deok-Bog
DB
Ahn
Chul-Soo
CS
Kim
Ki-Hun
KH
Hwang
Shin
S
Park
Kwang-Min
KM
Ha
Tae-Yong
TY
Ko
Gi-Young
GY
Sung
Kyu-Bo
KB
Song
Gi-Won
GW
Jung
Dong-Hwan
DH
Moon
Ki-Myung
KM
Kim
Bum-Soo
BS
Cho
Yong-Pil
YP
D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply*; D017741:Survivors; D016896:Treatment Outcome; D014463:Ultrasonography