Portal flow augmentation using meso-reno-portal anastomosis during liver transplantation with severe portal vein thrombosis

Abstract

This report introduces a novel strategy for modulating portal inflow during liver transplantation in a patient with portal vein thrombosis without evident systemic shunt formation. Two living donor liver transplantation cases which used meso-reno-portal anastomosis for portal flow augmentation were reviewed. Two patients with Yerdel's grade IV portal vein thrombosis without evident systemic shunt formation underwent successful living donor liver transplantation. The first patient had two jumping grafts from superior mesenteric vein and left renal vein anastomosed together which was concurrently anastomosed to the portal vein. For six months, both flows were patent and after six months, left renal vein flow was occluded leaving only superior mesenteric venous flow which was enough for the liver. The second patient had a jumping graft from left renal vein which was anastomosed in an end-to-side manner to the main portal vein which was concurrently anastomosed to the graft's portal vein. For three months, the patient had intact flow from both the portal vein and left renal vein. By these two cases, we report that in portal vein thrombosis without evident systemic shunt formation, meso-reno-portal anastomosis can augment the portal flow which can be beneficial for successful transplantation.