Left renal vein ligation for large splenorenal shunt during liver transplantation

Abstract

Adequate hepatopetal portal vein blood flow is obligatory to ensure proper liver function after liver transplantation. Large collateral veins as shunts impair portal vein flow and even cause hepatofugal blood flow and portal steal syndrome. In particular, splenorenal shunts in liver transplant recipients can lead to allograft dysfunction and possible allograft loss or hepatic encephalopathy. Restoration of portal flow through left renal vein ligation (LRVL) is a treatment option, which is much easier compared to splenectomy, renoportal anastomosis and shunt closure, but bears the risk of moderate and temporary impairment of renal function. In addition, a patent portal vein is mandatory for LRVL. However, although LRVL has been reported to be an effective, safe and easy method to control portacaval shunts and increase hepatopetal flow in some studies, indications and safety are still not clear. In this review, we summarize existing studies on LRVL during liver transplantation.

Impact of spontaneous splenorenal shunt on liver volume and long‐term survival of liver cirrhosis

“…Additionally, considering that constipation and high blood ammonia level are main predisposing factors for HE, the physicians should attempt to reduce blood ammonia and improve constipation by lactulose, l ‐ornithine l ‐aspartate, rifaximin, and branched chain amino acids 33 . Besides, as for SSRS, interventional treatments, such as balloon‐occluded retrograde transvenous obliteration, embolization of SSRS, and transjugular intrahepatic portosystemic shunt combined with Amplatzer plugging device, and surgery, such as splenectomy, left renal vein ligation, and renoportal anastomosis, should be considered 34–37 …”

The role of spontaneous portal-systemic shunts in liver transplantation: case report and literature review

“…Left renal vein ligation (LRVL) is considered as a safe and effective method to increase portal flow. If the portal flow is still poor (<1 L/min) after clamping the left renal vein (LRV), a renoportal anastomosis (RPA) or other surgical methods should be considered (17). It's worth noting that even some obvious shunts are ligated, post-operative recurrence of portal stealing phenomenon may also occur.…”

First experience in two successful consecutive pregnancies after simultaneous liver-kidney transplantation with reno-portal transposition

“…Причем формирование рено-портальной транспозиции является предпочтительным методом, поскольку при успешном выполнении сопряжено с меньшим количеством осложнений [1,14]. Однако эти методики большинством исследователей считаются наиболее сложными, связанными с высокой заболеваемостью и риском смерти реципиента в раннем послеоперационном периоде в случае неполной коррекции существующей портальной гипертензии, приводящей к скорой дисфункции печеночного графта [2][3][4][5][6][15][16][17]. Для достижения удовлетворительных результатов пациенты должны быть направлены в специализированные центры, хирургическая стратегия должна быть тщательно спланирована до трансплантации, могут потребоваться высокотехнологичные сосудистые вмешательства, в ряде случаев -индивидуальная техника трансплантации, не имеющая аналогов в мире [5,14,18,19].…”