title: Technical modification of reno-portal anastomosis in living donor liver transplantation for patients with obliterated portal vein and large spontaneous splenorenal shunts.
abstract: OBJECTIVE
  End-stage liver disease patients with obliterated portal vein(PV) and large spontaneous splenorenal shunts (SRS) are often indicated to renoportal bypass as a reconstruction of portal inflow during liver transplantation. The aim of this study was to show the feasibility and safety of the side-to-end (S-to-E) renoportal anastomosis (RP-A).
  
  
  METHODS
  RP-A were performed in 5 patients among 597 adult living donor liver transplantation (LDLT) with end-to-end (E-to-E) or S-to-E method interposing cadaveric fresh vessel grafts between left renal vein (LRV) and PV of liver graft from October 2005 to June 2008.
  
  
  RESULTS
  One patient underwent E-to-E RP-A, but it was technically difficult in our experience because of thin and retracted renal vein end under poor operation field. Remaining four patients underwent side-to-end (S-to-E) RP-A which allowed us to perform easy and secure anastomosis under better and more stable operation field, because LRV continuity with vena cava was preserved without retraction of anastomosis site. Except one patient having two left-lobes dual-graft LDLT who died from cerebral hemorrhage, four patients were recovered well with normal graft function and a patent RP-A.
  
  
  CONCLUSIONS
  S-to-E anastomosis is technically more feasible and easier method than E-to-E anastomosis for RP-A interposing cadaveric fresh vessel in LDLT.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Je-Ho
authors.initials: JH
authors.lastname: Ryu
authors.forename: Kwan-Woo
authors.initials: KW
authors.lastname: Kim
authors.forename: Nam-Kyu
authors.initials: NK
authors.lastname: Choi
authors.forename: GiYoung
authors.initials: G
authors.lastname: Ko
authors.forename: KyuBo
authors.initials: K
authors.lastname: Sung
authors.forename: SungKoo
authors.initials: S
authors.lastname: Lee
mesh_terms: D000328:Adult; D001011:Aorta / Q000637:transplantation; D001163:Arteriovenous Anastomosis; D005260:Female; D006801:Humans; D007084:Iliac Vein / Q000637:transplantation; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012079:Renal Circulation; D012082:Renal Veins / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods; D014682:Vena Cava, Inferior / Q000637:transplantation