Renoportal anastomosis in adult-to-adult living donor liver transplantation for patients with portal vein thrombosis in single center experience

Abstract

The anastomosis between the left renal vein and graft portal vein is one of the crucial options in patients with end-stage liver disease with portal venous thrombosis and a previous splenorenal shunt. However, especially in living donor liver transplantation (LDLT) practice, limited cases are published in the literature. Between January 2006 and December 2019, a total of 14 patients underwent adult LDLTs with renoportal anastomosis (RPA). The long-term outcomes were evaluated by reviewing the medical records of the 14 patients. Of the 14 patients who received adult LDLTs with RPA, 2 patients underwent end-to-end (E-to-E) RPA using left renal vein (LRV), 5 patients underwent side-to-end (S-to-E) RPA, and the rest underwent E-to-E RPA using LRV connected IVC cuff. Except two patients who died from cerebral hemorrhage and graft failure came from acute cellular rejection, twelve patients has maintained normal graft function and a patent RPA at a median follow-up of 42 months (range, 1-155 months). RPA can be performed safely and effectively in LDLT as an acceptable and life-saving procedure for patients with end-stage liver disease with portal venous thrombosis and a previous splenorenal shunt. According to our experience, E-to-E RPA using LRV connected IVC cuff is the best option considering feasibility and safety.