Abstract
Low portal vein flow after orthotopic liver transplantation due to spontaneous splenorenal shunt is associated with hepatic hypoperfusion and poor allograft survival. We describe a case of recovered portal flow by ligation of the left renal vein on the first postoperative day after orthotopic liver transplantation of a 54-year-old female with alcoholic cirrhosis, chronic kidney failure and spontaneous splenorenal shunt. After reperfusion portal flows were extremely low, but because of severe coagulopathy and diffuse bleeding, ligation of the left renal vein was not attempted. A relaparotomy was performed on the first postoperative day and the left renal vein was ligated at its confluence to the inferior vena cava. Portal flows subsequently increased and the patient presented a good and stable liver function. We conclude, that patients with known preoperative splenorenal shunts should be closely monitored and if the portal flow becomes insufficient, ligation of the left renal vein should be attempted in order to optimize the portal perfusion of the liver.
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