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

Abstract

INTRODUCTION:

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.

PRESENTATION OF CASE:

In this case series, we present our experience with reno-portal shunt as an alternative inflow for the liver allograft.

DISCUSSION:

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.

CONCLUSION:

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.

• Authors: Mustafa Nazzal, Yifei Sun, Obi Okoye, Laurence Diggs, Neil Evans, Tamara Osborn, Kambiz Etesami, Chintalapati Varma
• Journal: International journal of surgery case reports (Int J Surg Case Rep) Vol. 41 Pg. 251-254 ( 2017) ISSN: 2210-2612 [Print] Netherlands
• PMID: 29102862 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.