J Korean Soc Transplant.  2017 Jun;31(2):82-86. 10.4285/jkstn.2017.31.2.82.

Lessons Learned from Inappropriate Ligation of the Left Renal Vein for a Large Splenorenal Shunt in Living Donor Liver Transplantation

Affiliations
  • 1Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea. gshys@knu.ac.kr

Abstract

During living donor liver transplantation, a large spontaneous splenorenal shunt (SRS) should be addressed to obtain adequate portal inflow. Various procedures such as direct ligation of the SRS, splenectomy, left renal vein ligation (LRVL), and renoportal anastomosis can be applied to treat a large SRS according to the hemodynamics of the portal flow and anatomic conditions. Of these surgical procedures, LRVL is a simple and effective solution for treatment of a large SRS. However, to perform a LRVL, rigorous evaluation of the recipient's anatomic and hemodynamic variations is mandatory. In the present case, we ligated the left renal vein to treat a large SRS, which resulted in an unexpected thrombosis of the left renal vein and remaining portal vein stenosis in the SRS. Therefore, we revised our decisions regarding whether the LRVL was properly applied.

Keyword

Large splenorenal shunt; Left renal vein ligation; Renal vein thrombosis

MeSH Terms

Constriction, Pathologic
Hemodynamics
Humans
Ligation*
Liver Transplantation*
Liver*
Living Donors*
Portal Vein
Renal Veins*
Splenectomy
Splenorenal Shunt, Surgical*
Thrombosis

Figure

  • Fig. 1 Abdominal computed tomography performed 2 months before living donor liver transplantation showed a new hepatic mass, intrahepatic duct (IHD) stones, a large splenorenal shunt (SRS), and obliterated portal vein. (A) A new 4 cm diameter hepatic mass compatible with hepatocellular carcinoma (arrow). (B) Multiple IHD stones in both hemilivers (arrows). (C) Axial view: a large SRS (arrow). (D) Coronal view: obliterated portal vein with diameter of 6 mm (arrow) and a large SRS (arrowhead).

  • Fig. 2 On follow-up abdominal dynamic computed tomography, the left renal vein and a splenorenal shunt filled with thrombus, preserving the left gonadal vein patency. In addition, portal vein stenosis was observed. (A) Axial view: left renal vein thrombus (arrow) and a splenorenal shunt thrombus (arrowhead). (B) Coronal view: left renal vein thrombus (arrow) and a splenorenal shunt thrombus (arrowhead). (C) Coronal view: patent left gonadal vein (arrow) and portal vein stenosis (arrowhead).


Reference

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