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KMID : 0361120080220020267
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Korean Journal of Transplantation
2008 Volume.22 No. 2 p.267 ~ p.270
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Living-Donor Liver Transplantation with Renoportal Anastomosis using an Interposition Polytetrafluoroethylene Graft for a Patient with Large Spontaneous Splenorenal Shunt: A Case Report
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You Young-Kyoung
Kim Dong-Goo
Lee Sang-Kuon
Park Jung-Hyun
Lee Kyung-Keun
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Abstract
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Adequate portal perfusion is essential in liver transplantation. End-stage liver disease is often accompanied by a large spontaneous splenorenal shunt and poor portal flow. To secure an adequate portal perfusion of the graft, collaterals including splenorenal shunt should be interrupted during liver transplantation. However, this procedure is usually too demanding because of massive bleeding, as well as time-consuming. As in living-donor liver transplantation size-matched liver graft and vascular grafts are not always available, an alternative must be sought. We performed living-donor liver transplantation with renoportal anastomosis in a 52 year-old male with a large spontaneous splenorenal shunt. During surgery, left renal vein was divided at the caval junction and the distal stump was end-to-end anastomosed to the graft portal vein using 16 mm interposition polytetrafluoroethylene graft without ligation of collaterals. The initial postoperative course of this patient was uneventful. However, on postoperative day 6 and 12 perihepatic hematoma evacuation and portal vein graft thrombectomy were performed respectively. Since then, adequate portal blood flow and patency of the interposition polytetrafluoroethylene graft was maintained throughout the postoperative period. The patient was discharged with normal graft function 10 weeks after transplantation. Renoportal anastomosis using an interposition polytetrafluoroethylene graft in living-donor liver transplantation could be an acceptable alternative for patients with end-stage liver disease with a large spontaneous splenorenal shunt.
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KEYWORD
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Living-donor liver transplantation, Spontaneous splenorenal shunt, Renoportal anastomosis, Interposition polytetrafluoroethylene graft
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