RENAL-SPLENIC SHUNT FOR INFRAHEPATIC CAVAL OCCLUSION AFTER PIGGYBACK LIVER-TRANSPLANTATION

Inferior vena cava thrombosis after liver transplantation is uncommon. We describe a case of this unusual complication occurring after piggy -back (end-to-side) graft implantation. Renal failure, lower limb edem a, and hemodynamic instability were the presenting symptoms requiring immediate surgical correction with a left renal-to-splenic vein shunt over a ringed 2.5-cm prosthesis, The decision to go ahead with the shu nt was preceded by an intraoperative confirmation of a 10-cm H2O press ure gradient between the caval and portal circulations. This gradient, unlike that observed in liver cirrhosis, ultimately turned a splenore nal shunt into a renal-splenic one. Six months after the procedure, th e patient is alive and well with normal liver and renal function. The technique described may be useful in the management of other clinical conditions of acute infrahepatic caval hypertension.