title: Spontaneous Splenorenal Shunt in Liver Transplantation: Results of Left Renal Vein Ligation Versus Renoportal Anastomosis.
abstract: BACKGROUND
  Management of portal inflow to the graft in patients with spontaneous splenorenal shunts (SRS) is a matter of concern especially in case of large varices (more than 1 cm). In case of portal vein (PV) thrombosis (PVT), renoportal anastomosis (RPA) directly diverts the splanchnic and renal venous blood assuring a good portal inflow to the graft. Disconnection of the portacaval shunt by left renal vein ligation (LRVL) is another option but requires a patent PV. The indication of primary RPA rather than LRVL in patients with small native PV, especially in case of large graft, should be questioned in these complex cases of liver transplantation.
  
  
  METHODS
  From 1998 to 2012, 17 patients with RPA and 15 patients with LRVL were transplanted in our center. We compared these 2 techniques for short- and long-term results.
  
  
  RESULTS
  The rate of preliver transplantation PVT (76% vs 27%) and graft weight (1538 ± 383 g vs 1293 ± 216 g) was significantly higher in the RPA group. Renoportal anastomosis was performed in 4 cases of small but patent PV. Three-month mortality, morbidity, and massive ascitis were similar. No patient was retransplanted. One year after transplantation, PV diameter was still larger in RPA group. Three-year survival was similar (RPA: 79% vs LRVL: 53%, P = 0.1).
  
  
  CONCLUSIONS
  In cirrhotic patients transplanted with large splenorenal shunts, RPA and LRVL reach similar survivals. In case of complete PVT and failure of thrombectomy, the RPA offers satisfactory long-term results.
authors.affiliation: 1 AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, F-94800, France. 2 Inserm, Unité 1193, Villejuif, F-94800, France. 3 Univ Paris-Sud, UMR-S 1193, Villejuif, F-94800, France. 4 Inserm, Unité 776, Villejuif, F-94800, France. 5 Univ Paris-Sud, UMR-S 776, Villejuif, F-94800, France. 6 DHU Hepatinov, Villejuif, F-94800, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Golse
authors.forename: Petru Octav
authors.initials: PO
authors.lastname: Bucur
authors.forename: François
authors.initials: F
authors.lastname: Faitot
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bekheit
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pittau
authors.forename: Oriana
authors.initials: O
authors.lastname: Ciacio
authors.forename: Antonio
authors.initials: A
authors.lastname: Sa Cunha
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*