Renoportal Anastomosis during Liver Transplantation in Patients with Portal Vein Thrombosis: First long-term Results from a Multicenter Study

Abstract

Purpose: To evaluate the short- and long-term outcomes of renoportal anastomosis (RPA) in a large multicentric series. Summary Background: The current knowledge on RPA for portal reconstruction during liver transplantation (LT) in patients with diffuse portal vein thrombosis (PVT) and a large splenorenal shunt (SRS) is poor and limited to case reports and small case series. Method: All consecutive LTs with RPA performed in 5 centers between 1998 and 2020 were included. RPA was physiological provided it drained the splanchnic venous return through a large SRS (≥1 cm diameter). Complications of portal hypertension (PHT), long-term RPA patency, and patient and graft survival were assessed. RPA success was achieved provided the 3 following criteria were all fulfilled: patients were alive with patent RPA and without clinical PHT. Results: RPA was attempted and feasible in 57 consecutive patients and was physiological in 51 patients (89.5%). Ninety-day mortality occurred in 5 (8.5%) patients, and PHT-related complications occurred in 42.9% of patients. With a median follow-up of 63 months, the 1-, 3- and 5-year patient and graft survival rates were 87%, 83%, and 76% and 82%, 80%, and 73%, respectively. The primary and primary-assisted patency rates at 5 years were 84.5% and 94.3%, respectively. Success was achieved in 90% (27/30) of patients with a follow-up ≥ 5 years. Conclusions: Despite a high rate of PHT-related complications, excellent long-term patient and graft survival could be achieved. RPA could be considered successful in the vast majority of patients. The expanded use of RPA is warranted.