A Single-Center Experience in Portal Flow Augmentation in Liver Transplantation With Prior Large Spontaneous Splenorenal Shunt

Kısaoğlu, Abdullah; Dandin, Özgür; Demiryılmaz, İsmail; Dinc, Bora; Adanir, Haydar; Yılmaz, Vural Taner; Aydınlı, Bülent

doi:10.1016/j.transproceed.2020.05.015

Cited by 5 publications

(3 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the procedure is complicated and may require an additional interposed vein graft to connect the left RV to the PV. Additionally, because PV flow is derived from both a large SRS and the left renal vein, portal hyperperfusion can occur during living donor LT (PFV >250 ml/100 g/min) ( 11 , 19 ). A recent study reported a 31.3% (5/16) incidence of upper gastrointestinal bleeding and 43.8% (7/16) incidence of postoperative ascites when portal hypertension was not fully relieved after RPA ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

“…Surgical procedures used for SRS during LT include renoportal anastomosis (RPA) ( 4 , 10 , 11 ), left renal vein ligation (LRVL) ( 4 , 11 , 12 ), splenectomy ( 13 ), and splenic vein ligation ( 11 ). There have been relatively few reports of direct SRS ligation ( 6 ) and these studies only focused on the surgical technique, with no details on the hemodynamic consequences of the procedure.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation

Chen

Li²,

Zhang³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

BackgroundA large spontaneous splenorenal shunt (SRS) will greatly impact portal inflow to the graft during liver transplantation (LT). Direct ligation of a large SRS is an uncommon surgical procedure and the hemodynamic consequences of this procedure are unknown.MethodsIn this retrospective study, we described our technique for direct ligation of a large SRS and the consequent hemodynamic changes during LT. 3-Dimensional computed tomography and Doppler ultrasonography were used to evaluate SRS and portal vein blood flow volume (PFV).ResultsA total of 22 recipients had large SRS including 13 with PFV <85 ml/min/100 g (ligation group) and 9 with PFV ≥85 ml/min/100 g (no ligation group). The diameter of SRS was significantly larger in the ligation group than in the non-ligation group (22.92 ± 4.18 vs. 16.24 ± 3.60 mm; p = 0.0009). In all ligation patients, the SRS was easily identified and isolated, it was located just below the distal pancreas and beside the inferior mesenteric vein. PV flow increased significantly from 68.74 ± 8.77 to 116.80 ± 16.50 ml/min/100 g (p < 0.0001) after ligation; this was followed by a reduction in peak systolic velocity of the hepatic artery from 58.17 ± 14.87 to 46.67 ± 13.28 cm/s (p = 0.0013).ConclusionsDirect ligation of large SRS was an effective and safe surgical procedure to overcome the problem of portal hypoperfusion during LT.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation

Chen

Li²,

Zhang³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

show abstract

“…A relatively easy method to overcome this 'steal' and augment portal inflow is by performing a left renal vein ligation (LRVL). Literature with regards to its renal implications remain sparse, nonetheless a few series based on other abdominal surgery have attested to its renal safety [4][5][6][7]. However, given the fragile renal status of most patients with end stage liver disease, it may not be entirely appropriate to extrapolate those results to the LT setting.…”

Section: Introductionmentioning

confidence: 99%

Renal Implications of Left Renal Vein Ligation for Portal Flow Augmentation in Liver Transplantation

et al. 2021

View full text Add to dashboard Cite

Background Spontaneous lienorenal shunts (SLS) siphon blood away from the portal circulation and may compromise portal inflow in liver transplantation (LT). Performing a left renal vein ligation (LRVL) is a relatively easy and efficacious method of overcoming this portal 'steal'. However, given the delicate state of renal function in these patients, its short and long term effects remain undefined. The aim of this study was to evaluate the efficacy of LRVL in augmenting portal flow and safety with regards to renal function. Methods A prospectively collected database of 1638 consecutive LT recipients between January 2010 and August 2020 was reviewed. Twenty-eight patients who underwent LRVL were identified. There were six paediatric recipients, who were analysed separately. Data with regards to imaging, renal function, intraoperative portal hemodynamics, and renal morbidity were analysed. Results Of the 22 adults, 21 underwent live donor LT. 22.5% had a pre-transplant history of acute kidney injury (AKI). Pre-operative CT demonstrated portal vein thrombosis and SLS in 63.6% and 92.9% of patients respectively. LRVL resulted in a significant augmentation of portal hemodynamics in both the adult and paediatric recipients. Postoperatively, 14.3% and 35.7% of patients developed chylous drain output and AKI respectively. Of 13 patients who underwent CT at various timeframes, 5 patients had a partial re-canalisation of LRV at 6 months. Conclusion From renal and portal standpoints, LRVL is a safe and effective technique of augmenting portal inflow. Further large-scale multicentre studies and consensus will help define an objective algorithmic approach to LT recipients with SLS.

show abstract

Management of spontaneous portosystemic shunts at the time of liver transplantation: treatment or observation? Results of a systematic review

et al. 2022

View full text Add to dashboard Cite

A Single-Center Experience in Portal Flow Augmentation in Liver Transplantation With Prior Large Spontaneous Splenorenal Shunt

Cited by 5 publications

References 40 publications

Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation

Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation

Renal Implications of Left Renal Vein Ligation for Portal Flow Augmentation in Liver Transplantation

Management of spontaneous portosystemic shunts at the time of liver transplantation: treatment or observation? Results of a systematic review

Contact Info

Product

Resources

About