title: Safety and effectiveness of renoportal bypass in patients with complete portal vein thrombosis: an analysis of 10 patients.
abstract: The presence of portal vein thrombosis (PVT) is still considered by many transplantation centers to be an absolute contraindication to liver transplantation because of the technical difficulties that it can present and its association with a higher rate of patient morbidity and mortality. Renoportal bypass (RPB) can help to remove these barriers. This study describes our institution's experience with RPB through the description of a new and successful simplified surgical strategy, a patient and graft outcome analysis, intraoperative vascular flow measurements, and the use of splenic artery embolization (SAE) as an effective adjunct for treating sporadic cases of unrelieved portal hypertension. Between January 2004 and January 2013, 10 patients with grade 4 PVT underwent RPB. At the last follow-up (42.2 ± 21.1 months), the patient and graft survival rates were 100%. Five patients (50%) experienced posttransplant ascites, and 2 of those underwent proximal SAE to modulate the liver inflow and overcome the ascites. Three patients (30%) experienced transient kidney injury in the early posttransplant period and were treated efficiently with medical therapy. The renoportal flows were close to the desirable 100 mL/100 g of liver tissue in all cases. The experience and data support RPB as a feasible and easily reproducible technique without the risks and technical challenges associated with the tedious dissection of a cavernous hilum.
authors.affiliation: Transplantation Center, Department of General Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.forename: Mario
authors.initials: M
authors.lastname: Spaggiari
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Federico
authors.initials: F
authors.lastname: Aucejo
authors.forename: Teresa
authors.initials: T
authors.lastname: Diago
authors.forename: Masato
authors.initials: M
authors.lastname: Fujiki
authors.forename: Charles
authors.initials: C
authors.lastname: Winans
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Amico
authors.forename: Loris
authors.initials: L
authors.lastname: Trenti
authors.forename: Dympna
authors.initials: D
authors.lastname: Kelly
authors.forename: Bijan
authors.initials: B
authors.lastname: Eghtesad
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000628:therapy; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D004621:Embolization, Therapeutic; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery*; D012082:Renal Veins / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*