Spontaneous splenorenal shunt in liver transplantation

Results of left renal vein ligation versus renoportal anastomosis

Nicolas Golse, Petru Octav Bucur, François Faitot, Mohamed Bekheit, Gabriella Pittau, Oriana Ciacio, Antonio Sa Cunha, Rene Adam, Denis Castaing, Didier Samuel, Daniel Cherqui, Eric Vibert*

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

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. From1998 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.

Original languageEnglish
Pages (from-to)2576-2585
Number of pages10
JournalTransplantation
Volume99
Issue number12
DOIs
Publication statusPublished - Dec 2015

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Surgical Splenorenal Shunt
Renal Veins
Liver Transplantation
Ligation
Portal Vein
Transplants
Thrombosis
Transplantation
Surgical Portacaval Shunt
Thrombectomy
Survival
Viscera
Varicose Veins
Morbidity
Kidney
Weights and Measures
Mortality

ASJC Scopus subject areas

  • Transplantation

Cite this

Spontaneous splenorenal shunt in liver transplantation : Results of left renal vein ligation versus renoportal anastomosis. / Golse, Nicolas; Bucur, Petru Octav; Faitot, François; Bekheit, Mohamed; Pittau, Gabriella; Ciacio, Oriana; Cunha, Antonio Sa; Adam, Rene; Castaing, Denis; Samuel, Didier; Cherqui, Daniel; Vibert, Eric.

In: Transplantation, Vol. 99, No. 12, 12.2015, p. 2576-2585.

Research output: Contribution to journalArticle

Golse, N, Bucur, PO, Faitot, F, Bekheit, M, Pittau, G, Ciacio, O, Cunha, AS, Adam, R, Castaing, D, Samuel, D, Cherqui, D & Vibert, E 2015, 'Spontaneous splenorenal shunt in liver transplantation: Results of left renal vein ligation versus renoportal anastomosis', Transplantation, vol. 99, no. 12, pp. 2576-2585. https://doi.org/10.1097/TP.0000000000000766
Golse, Nicolas ; Bucur, Petru Octav ; Faitot, François ; Bekheit, Mohamed ; Pittau, Gabriella ; Ciacio, Oriana ; Cunha, Antonio Sa ; Adam, Rene ; Castaing, Denis ; Samuel, Didier ; Cherqui, Daniel ; Vibert, Eric. / Spontaneous splenorenal shunt in liver transplantation : Results of left renal vein ligation versus renoportal anastomosis. In: Transplantation. 2015 ; Vol. 99, No. 12. pp. 2576-2585.
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T1 - Spontaneous splenorenal shunt in liver transplantation

T2 - Results of left renal vein ligation versus renoportal anastomosis

AU - Golse, Nicolas

AU - Bucur, Petru Octav

AU - Faitot, François

AU - Bekheit, Mohamed

AU - Pittau, Gabriella

AU - Ciacio, Oriana

AU - Cunha, Antonio Sa

AU - Adam, Rene

AU - Castaing, Denis

AU - Samuel, Didier

AU - Cherqui, Daniel

AU - Vibert, Eric

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N2 - 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. From1998 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.

AB - 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. From1998 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.

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