Intervention on Spontaneous Splenorenal Shunt May Decrease the Incidence of Acute Kidney Injury After Liver Transplant

• Published in: Experimental and clinical transplantation 2020-06, Vol.18 (3), p.320-324
• Main Authors: Nickkholgh, Arash, Wang, Jingzhou, Shahbazov, Rauf, Pelletier, Shawn, Maluf, Daniel
• Format: Article
• Language: English
• Subjects: Tıp
• ISSN: 1304-0855; 2146-8427
• DOI: 10.6002/ect.2019.0248

Objectives: Spontaneous splenorenal shunt is a type of portosystemic shunt that develops frequently in the setting of chronic portal hypertension. It remains controversial whether shunt interventions during liver transplant improve transplant outcomes. Materials and Methods: We conducted a retrospective comparison between deceased-donor liver transplant recipients who received spontaneous splenorenal shunt intervention and those who did not at a tertiary center between 2012 and 2017. Primary outcomes of interest included intraoperative transfusion requirement, hospital length of stay, acute kidney injury posttransplant, portal vein thrombosis, throm - bocytopenia, and 1-year graft and patient survival. Results: Of 268 liver transplant recipients, 50 (18.6%) had large spontaneous splenorenal shunts pre - transplant, with 45 patients having available radiologic and outcome data. Nine of 45 patients (20%) received shunt intervention, including pretransplant balloonoccluded retrograde transvenous obliteration (n = 5), intraoperative ligation of the left renal vein (n = 3), and intraoperative direct shunt ligation (n = 1). Demographic data, clinical characteristics, and Model for End-Stage Liver Disease scores were not different between the intervention and the nonintervention groups. Intraoperative transfusion, length of hospi - talization, portal vein thrombosis, thrombocytopenia, and 1-year graft and patient survival were also similar between the 2 groups. However, the rate of posttransplant acute kidney injury was significantly lower in patients in the intervention group (0 cases vs 12 cases; odds ratio = 0.73; 95% confidence interval, 0.59-0.90). Patients with no SRS intervention (n = 36) were followed radiologically for 1 year posttransplant, with follow-up data showing complete resolution of spontaneous splenorenal shunt in just 4 patients (15%) and no changes in the remaining patients. Conclusions: Peritransplant interventions for spon - taneous splenorenal shunt may reduce posttransplant acute kidney injury. In patients without intervention, spontaneous splenorenal shunt predominantly persisted 1 year posttransplant.