Ann Liver Transplant.  2022 Nov;2(2):139-143. 10.52604/alt.22.0016.

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

• Rhu J
• Choi GS
• Kim JM
• Joh JW

• KMID: 2560909
• DOI: http://doi.org/10.52604/alt.22.0016

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.

Keyword

Portal vein; Liver transplantation; Mesenteric vein; Transplantation

Figure

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  Figure 1 Image findings of patients with severe PVT before and after transplantation who underwent living donor liver transplantation with portal flow augmentation combining jump graft from SMV and jump graft from LRV. (A, B) preoperative computed tomography and (C) three-dimensionally reconstructed view of PVT extending to the mesenteric-splenic junction. (D, E) postoperative computed tomography and (F) three-dimensionally reconstructed view of PVT extending deep inside the SMV. PVT, portal vein thrombosis; SMV, superior mesenteric vein; SV, splenic vein; LRV, left renal vein; PV, portal vein.

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  Figure 2 Image findings of patients with severe PVT before and after transplantation who underwent living donor liver transplantation with portal flow augmentation combining portal flow and jump graft from LRV. (A, B) preoperative computed tomography and (C) three-dimensionally reconstructed view of PVT extending to the mesenteric-splenic junction. (D, E) postoperative computed tomography and (F) three-dimensionally reconstructed view of PVT extending deep inside the SMV. PVT, portal vein thrombosis; SMV, superior mesenteric vein; SV, splenic vein; LRV, left renal vein; gPV, graft side portal vein; rPV, recipient side portal vein; PV, portal vein.

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