Liver transplantation in patients with spontaneous spleno-renal shunt

Abstract

Aim: Our aim was to describe the outcomes of liver transplantation (LT) in patients with spontaneous spleno-renal shunt (SSRS) and a defined protocol of mínimum portal flow. Methods: Recipients with SSRS before LT between January 2005 and January 2017 were included in a retrospective study. Our policy was to achieve a final portal flow >80 mL/min/100 gr of liver weight or >1000 mL/min. The primary endpoint was patient survival. Results: Sixty patients comprised the study group. Portal thrombendvenectomy was performed in 15. Portal reconstruction was porto-portal in 56 cases, including 9 cases with left renal vein (LRV) ligation. Reno-portal reconstruction was performed in 4 cases. Median portal flow in those patients with LRV ligation increased from 850 mL/min (266-1419) to 1732 mL/min (1063-3240) after ligation. This was comparable to the patients with porto-portal reconstruction and no need for LRV ligation (1782 mL/min (672-3780)). Moreover, median portal flow/100 gr of liver weight increased from 56 mL (34-79) to 111 mL (61-183) after LRV ligation, also comparable to the patients who did not need LRV ligation (118 mL (69-295)). Mean (SD) portal flow after reno-portal reconstruction was 1372 ± 798 mL/min. Early primary dysfunction was observed in 12 patients (20%). Only 1 patient suffered a primary non-function.1- and 5-year patient survival was 93.3% and 91%. Conclusión: A high patient survival was observed after LT in recipients with pretransplant SSRS when a final portal flow >80 mL/min/100 gr of liver weight or >1000 mL/min was achieved.