Renoportal Anastomosis in Left Lateral Lobe Living Donor Liver Transplantation: A Pediatric Case

Abstract

In adult liver transplantation, renoportal anastomosis (RPA) has been introduced as a useful technique for patients with grade 4 portal vein thrombosis and a splenorenal shunt. Here, we report a pediatric case in which RPA allowed a left lateral lobe living donor liver transplantation (LDLT) despite portal vein thrombosis and a large splenorenal shunt. At 36 days old, the patient underwent a Kasai operation for biliary atresia. At 17 months old, she underwent LDLT because of repetitive cholangitis. Pretransplant examinations revealed a large splenorenal shunt and portal vein thrombosis. Simple end-to-end portal reconstruction and clamping of the collateral route after removing the thrombosis were unsuccessful. Thus, RPA was performed using a donor superficial femoral vein as an interpositional graft. The portal vein pressure was 20 mm Hg after arterial reperfusion. Ligation of the splenic artery reduced the portal vein pressure. Although she developed severe acute cellular rejection and chylous ascites, there were no signs of portal vein complications. She was discharged 73 days after transplantation without any signs of renal dysfunction. The patient’s condition was good at her last follow-up, 22 months after transplantation. To our knowledge, this is the youngest case of RPA in pediatric left lateral lobe LDLT. Additionally, this is the first case of RPA with splenic artery ligation and using the donor’s superficial femoral vein as the venous graft for RPA. Although long-term follow-up is necessary, RPA could be a salvage option in LDLT in infants if other methods are unsuccessful.

First experience in two successful consecutive pregnancies after simultaneous liver-kidney transplantation with reno-portal transposition

“…Причем формирование рено-портальной транспозиции является предпочтительным методом, поскольку при успешном выполнении сопряжено с меньшим количеством осложнений [1,14]. Однако эти методики большинством исследователей считаются наиболее сложными, связанными с высокой заболеваемостью и риском смерти реципиента в раннем послеоперационном периоде в случае неполной коррекции существующей портальной гипертензии, приводящей к скорой дисфункции печеночного графта [2][3][4][5][6][15][16][17]. Для достижения удовлетворительных результатов пациенты должны быть направлены в специализированные центры, хирургическая стратегия должна быть тщательно спланирована до трансплантации, могут потребоваться высокотехнологичные сосудистые вмешательства, в ряде случаев -индивидуальная техника трансплантации, не имеющая аналогов в мире [5,14,18,19].…”

Bleeding from jejunal varices formed at the Roux-en-Y jejunum site caused by the compression of the left renal vein after living donor liver transplantation with renoportal anastomosis

“…However, there are few reports concerning pediatric cases and long-term results. We report the youngest case of a female pediatric LDLT performed with RPA [3]. During the patient's follow-up period, gastrointestinal bleeding from varices of the Roux-en-Y (RY) jejunum occurred.…”