Liver transplantation with renoportal anastomosis after distal splenorenalshunt

Background: The distal splenorenal shunt (DSRS) is designed to maintain hep atopetal portal vein flow while decompressing gastroesophageal varices. How ever, over time, as the underlying liver disease progresses, the DSRS loses its selectivity. The most common method of addressing this issue during or thotopic liver transplantation is shunt ligation with or without splenectom y. Dismantling the shunt increases the complexity of the transplantation, a nd splenectomy may increase the risk of infection. Hypothesis: Anastomosis of the donor portal vein to the left renal vein wit hout dismantling the shunt is an effective method of portal vein reconstruc tion for patients with a patent DSRS. Design: Retrospective analysis. Setting: University-based teaching hospital, Miami, Fla. Patients: Five liver transplant recipients with patent DSRS who received an orthotopic liver transplant between September 1996 and August 1999. Interventions: The donor portal vein was anastomosed end-to-end to the left renal vein during liver transplantation. Main Outcome Measures: Perioperative morbidity, portal vein flow by Doppler study, patient survival, and graft survival. Results: In all patients, the graft liver reperfused promptly via flow thro ugh the left renal vein with adequate decompression of the bowel. Normal po rtal venous flow was demonstrated by intraoperative and postoperative Doppl er ultrasound studies. At the mean follow-up of 16 months, dr patients were alive with well-functioning grafts. Conclusions: This novel technique has the advantage of decreasing the compl exity of the procedure, without requiring splenectomy, while securing adequ ate portal perfusion. Additionally, it can be applied without modifications in patients with portal vein thrombosis.