Technical modification of reno-portal anastomosis in living donor liver transplantation for patients with obliterated portal vein and large spontaneous splenorenal shunts.

摘要

BACKGROUND/AIMS: End-stage liver disease patients with obliterated portal vein(PV) and large spontaneous splenorenal shunts (SRS) are often indicated to renoportal bypass as a reconstruction of portal inflow during liver transplantation. The aim of this study was to show the feasibility and safety of the side-to-end (S-to-E) renoportal anastomosis (RP-A). METHODOLOGY: RP-A were performed in 5 patients among 597 adult living donor liver transplantation (LDLT) with end-to-end (E-to-E) or S-to-E method interposing cadaveric fresh vessel grafts between left renal vein (LRV) and PV of liver graft from October 2005 to June 2008. RESULTS: One patient underwent E-to-E RP-A, but it was technically difficult in our experience because of thin and retracted renal vein end under poor operation field. Remaining four patients underwent side-to-end (S-to-E) RP-A which allowed us to perform easy and secure anastomosis under better and more stable operation field, because LRV continuity with vena cava was preserved without retraction of anastomosis site. Except one patient having two left-lobes dual-graft LDLT who died from cerebral hemorrhage, four patients were recovered well with normal graft function and a patent RP-A. CONCLUSIONS: S-to-E anastomosis is technically more feasible and easier method than E-to-E anastomosis for RP-A interposing cadaveric fresh vessel in LDLT.