Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Feb 24, 2017; 7(1): 94-97
Published online Feb 24, 2017. doi: 10.5500/wjt.v7.i1.94
Renoportal anastomosis in living donor liver transplantation with prior proximal splenorenal shunt
Fatih Ozdemir, Koray Kutluturk, Bora Barut, Perviz Abbasov, Ramazan Kutlu, Cuneyt Kayaalp, Sezai Yılmaz
Fatih Ozdemir, Koray Kutluturk, Bora Barut, Cuneyt Kayaalp, Sezai Yılmaz, Department of Surgery, Liver Transplantation Institute of Inonu University, 44280 Malatya, Turkey
Perviz Abbasov, Department of Surgery, Azerbaijan Medical School, Baku, AZ 1000, Azerbaijan
Ramazan Kutlu, Department of Radiology, Liver Transplantation Institute of Inonu University, 44280 Malatya, Turkey
Author contributions: Ozdemir F designed and wrote the paper; Kutluturk K, Barut B and Abbasov P collected the patient’s data; Kutlu R interpreted the radiological imagination; Kayaalp C and Yılmaz S reviewed the paper.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Inonu University, Malatya, Turkey.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Fatih Ozdemir, Department of Surgery, Liver Transplantation Institute of Inonu University, Elazig Road 15th km., 44280 Malatya, Turkey. fatihup@hotmail.com
Telephone: +90-533-5475078
Received: October 1, 2016
Peer-review started: October 11, 2016
First decision: November 10, 2016
Revised: December 30, 2016
Accepted: January 16, 2017
Article in press: January 18, 2017
Published online: February 24, 2017
Abstract

For transplant surgeons, end-stage liver disease with portal venous thrombosis and a previous splenorenal shunt (SRS) is a significant challenge during liver transplantation. Thrombosis of the portal vein can be corrected by surgical interventions, such as portal venous thrombectomy or surgical removal of the thrombosed portal vein. Even also placement of a graft between the mesenteric vein and the graft portal vein can be performed. If these maneuvers fail, a renoportal anastomosis (RPA) can be performed to achieve adequate graft inflow. A 51-year-old male patient who had a history of proximal SRS and splenectomy underwent living donor liver transplantation (LDLT) due to cryptogenic cirrhosis. LDLT was performed with RPA using a cadaveric iliac vein graft. The early postoperative course of the patient was completely uneventful and he was discharged 20 d after transplantation. To the best of our knowledge, this was the first patient to receive LDLT with RPA after surgical proximal SRS and splenectomy.

Keywords: Liver transplantation, Portal vein thrombosis, Renoportal anastomosis, Proximal splenorenal shunt

Core tip: Renoportal anastomosis is such a feasible option during liver transplantation especially for patients having portal vein thrombosis. This case has a history of surgical proximal splenorenal shunting and splenectomy before liver transplantation which is a rare condition that makes surgery more complex and difficult. We reported how we managed our patient.