A Case of Left Renal Vein Ligation in a Patient with Solitary Left Kidney Undergoing Liver Transplantation to Control Splenorenal Shunt and Improve Portal Venous Flow

摘要

Objective: Rare co-existance of disease or pathologyBackground: Adequate portal venous flow is required for successful liver transplantation. Reduced venous flow and blood flow ‘steal’ by collateral vessels are a concern, and when there is a prominent splenorenal shunt present, liga- tion of the left renal vein has been recommended to improve portal venous blood flow. Case Report: A 51-year-old man who had undergone right nephrectomy in childhood required liver transplantation for liver cirrhosis and hepatocellular carcinoma due to hepatitis C virus (HCV) infection. The patient had no other co- morbidity and no history of hepatorenal syndrome. At transplantation surgery, portal venous flow was poor and did not improve with ligation of shunt veins, but ligation of the left renal vein improved portal venous flow. On the first and fifth postoperative days, the patient was treated with basiliximab, a chimeric monoclonal anti- body to the IL-2 receptor, and methylprednisolone. The calcineurin inhibitor, tacrolimus, was introduced on the fifth postoperative day. On the sixteenth postoperative day, renal color Doppler ultrasound showed normal left renal parenchyma; hepatic Doppler ultrasound showed good portal vein flow and preserved hepatic parenchy- ma in the liver transplant.Conclusions: This case report has shown that in a patient with a single left kidney, left renal vein ligation is feasible and safe in a patient with no other risk factors for renal impairment following liver transplantation. Modification of post- operative immunosuppression to avoid calcineurin inhibitors in the very early postoperative phase may be im- portant in promoting good recovery of renal function and to avoid the need for postoperative renal dialysis.