Renoportal Anastomosis as a Rescue Technique in Postoperative Portal Thrombosis in Liver Transplantation

González-Pinto, I; Miyar, A.; García-Bernardo, Carmen; Vázquez, L; Barneo, L; Cortés, Enrique Claver; Díaz, P.; Gutiérrez, Néstor; Fernández, L.M. Rodríguez; Moreno, María Begoña Prieto

doi:10.1016/j.transproceed.2009.02.026

Cited by 13 publications

(11 citation statements)

References 4 publications

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“…In renoportal anastomosis, the portal inflow comes from the left renal vein which is directly anastomosed to the donor's portal vein in and end-to-end fashion [58,[61][62][63] (Fig. 4).…”

Section: Patients With Diffuse Splanchnic Vein Thrombosismentioning

confidence: 99%

Portal vein thrombosis, cirrhosis, and liver transplantation

Francoz

Valla

Durand

2012

Journal of Hepatology

224

265

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“…In renoportal anastomosis, the portal inflow comes from the left renal vein which is directly anastomosed to the donor's portal vein in and end-to-end fashion [58,[61][62][63] (Fig. 4).…”

Section: Patients With Diffuse Splanchnic Vein Thrombosismentioning

confidence: 99%

Portal vein thrombosis, cirrhosis, and liver transplantation

Francoz

Valla

Durand

2012

Journal of Hepatology

224

265

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“…Reno‐portal anastomosis (RPA) has been proposed as an alternative strategy to establish a portal inflow in patients undergoing LT with extensive SVT or an obliterated PV as a result of phlebosclerosis . An RPA can be performed between the left renal vein and the allograft's PV in an end‐to‐end or side‐to end fashion, with or without an interposition graft.…”

Section: Introductionmentioning

confidence: 99%

Renoportal anastomosis in liver transplantation and its impact on patient outcomes: a systematic literature review

et al. 2018

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Portal vein thrombosis (PVT) is commonly encountered during liver transplantation (LT). Depending on the grade of thrombosis, varied management strategies are indicated. The aims of this study are to clarify the contemporary role of renoportal anastomosis (RPA) in patients with splanchnic vein thrombosis (SVT) undergoing LT and to systematically analyze all reported cases of RPA. A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta‐ Analyses statement guidelines. The study was limited to studies reported in English between January 1997 and May 2017. Only retrospective single center studies were included in the analysis. A total of 66 patients with SVT were reported to have undergone RPA during LT. Transient renal dysfunction was reported in 12 patients (18.1%), variceal hemorrhage in 2 patients (3%), early portal vein (PV) re‐thrombosis in 2 patients (3%), chronic renal dysfunction in 2 patients (3%), and late PV re‐thrombosis in 1 patient (1.5%). The overall patient and graft survival were each 80%. This analysis illustrates the decades‐long evolution of a technique practiced across the field of transplantation. Postoperative complications and graft survival appear to be encouraging, even in the setting of SVT.

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“…Before this study, the literature had described only 35 cases in which RPB had been used in patients with PVT, despite strong indications of its usefulness …”

Section: Discussionmentioning

confidence: 99%

Safety and effectiveness of renoportal bypass in patients with complete portal vein thrombosis: An analysis of 10 patients

et al. 2015

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The presence of portal vein thrombosis (PVT) is still considered by many transplantation centers to be an absolute contraindication to liver transplantation because of the technical difficulties that it can present and its association with a higher rate of patient morbidity and mortality. Renoportal bypass (RPB) can help to remove these barriers. This study describes our institution's experience with RPB through the description of a new and successful simplified surgical strategy, a patient and graft outcome analysis, intraoperative vascular flow measurements, and the use of splenic artery embolization (SAE) as an effective adjunct for treating sporadic cases of unrelieved portal hypertension. Between January 2004 and January 2013, 10 patients with grade 4 PVT underwent RPB. At the last follow-up (42.2 6 21.1 months), the patient and graft survival rates were 100%. Five patients (50%) experienced posttransplant ascites, and 2 of those underwent proximal SAE to modulate the liver inflow and overcome the ascites. Three patients (30%) experienced transient kidney injury in the early posttransplant period and were treated efficiently with medical therapy. The renoportal flows were close to the desirable 100 mL/100 g of liver tissue in all cases. The experience and data support RPB as a feasible and easily reproducible technique without the risks and technical challenges associated with the tedious dissection of a cavernous hilum. See Editorial on Page 275Portal vein thrombosis (PVT) is a well-recognized complication in patients with cirrhosis, with a reported incidence ranging between 5% and 15%.1 At one time, the presence of PVT was considered an absolute contraindication to liver transplantation (LT) because of the technical difficulties that it can present during transplantation and its association with a higher rate of patient morbidity and mortality. These difficulties include excessive bleeding and the inability to establish adequate portal blood flow, which results in allograft dysfunction. Although experience and improved surgical techniques have helped to reduce the occurrence of these complications and have enabled patients with PVT to undergo successful transplantation, surgical complexity and perioperative morbidity and mortality rates persist as barriers to transplantation for these patients at many institutions. Renoportal bypass (RPB) can help to remove these barriers by reducing surgical complexity and improving perioperative outcomes for transplant recipients with PVT and a concomitant splenorenal shunt (SRS).This study describes our institution's experience with RPB. RPB was described a decade ago by Kato

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Renoportal Anastomosis as a Rescue Technique in Postoperative Portal Thrombosis in Liver Transplantation

Cited by 13 publications

References 4 publications

Portal vein thrombosis, cirrhosis, and liver transplantation

Portal vein thrombosis, cirrhosis, and liver transplantation

Renoportal anastomosis in liver transplantation and its impact on patient outcomes: a systematic literature review

Safety and effectiveness of renoportal bypass in patients with complete portal vein thrombosis: An analysis of 10 patients

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