Reno-portal shunt for liver transplant, an alternative inflow for recipients with grade III–IV portal vein thrombosis: Tips for a better outcome

• Published in: International journal of surgery case reports 2017-01, Vol.41, p.251-254
• Main Authors: Nazzal, Mustafa, Sun, Yifei, Okoye, Obi, Diggs, Laurence, Evans, Neil, Osborn, Tamara, Etesami, Kambiz, Varma, Chintalapati
• Format: Article
• Language: English
• Subjects: Case series; Orthotopic liver transplant; Portal vein thrombosis; Reno-portal shunt; Spleno-renal shunt
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2017.09.028

•Grade III,IV Portal vein thrombosis Poses a Great challenge to orthotopic liver transplantation.•We present two cases of reno-portal anastomosis to establish inflow to the new liver allograft.•Meticulous preoperative planning with triple phase CT to measure the diameter of spleno-renal shunt, along with Duplex scan confirming antegrade flow towards the renal vein is essential for a better outcome. Portal vein thrombosis (PVT) poses an extremely difficult problem in cirrhotic patients who are in need of a liver transplant. The prevalence of PVT in patients with cirrhosis ranges from 0.6% to 26% Nery et al. (2015) [1]. The presence of PVT is associated with more technically difficult liver transplant and in certain cases can be a contraindication to liver transplant. The only option for these patients with extensive PVT would be a multi-visceral transplant, the later unfortunately has a much higher morbidity and mortality compared to liver only transplant Smith et al. (2016) [2]. An alternative approach is needed to provide a safe and reliable outcome. In this case series, we present our experience with reno-portal shunt as an alternative inflow for the liver allograft. This approach appears to be safe with good long-term outcome.Although this technique has been described before, we provide additional considerations that produced good outcomes in our patients. We believe that meticulous preoperative planning with high-resolution triple phase CT imaging with a measurement of the diameter of the spleno-renal shunt along with a duplex scan measuring flow through the shunt is key to a successful transplantation. Moreover, appropriate donor liver size is also of extreme importance to avoid portal hypoperfusion.