The presence of large spontaneous splenorenal shunts (SSRS) is a risk factor for low portal flow and graft dysfunction after liver transplantation (LT). Left renal vein ligation (LRVL) is a recent option when shunt interruption is necessary during LT.

A retrospective analysis was performed of 55 patients submitted to LRVL (LRVL+ group) compared to a contemporaneous control group of 50 LT patients without LRVL (LRVL- group). Kidney dysfunction was defined as serum creatinine > 1.5 mg/dl.

LRVL was performed during LT in 52 (94.5%) patients and as a post-transplant rescue maneuver in three patients. LRVL+ patients exhibited lower rate of gastrointestinal bleeding (18% vs. 40%; p=0.01) and ascites (44% vs. 66%; p=0.02), a higher frequency of encephalopathy (76% vs. 54%; p=0.01), and higher serum indirect bilirubin (2.28 vs. 1.44 mg/dl; p=0.01) preoperatively. The MELD score was similar between the groups (20.7 vs. 20.5; p=0.87). After LT, the frequency of kidney dysfunction (34% vs. 42%; p=0.43), the need for dialysis (31% vs. 22%; p=0.30), the frequency of portal vein thrombosis (3.6% vs. 0; p=0.17), 1-year patient (76% vs. 82%; p=0.47) and graft (73% vs. 82%; p=0.25) survival were similar between LRVL+ and LRVL- groups, respectively.

In conclusion, LRVL was found to be a simple and efficient procedure to increase the portal flow during LT for patients with large SSRS, followed by similar outcomes regarding portal vein thrombosis and kidney function when compared to the group without this technical maneuver.

CITATION INFORMATION: Perosa M., Noujaim H., Branez J., Mota L., Zeballos B., Santos R., Watanabe A., Ferreira G., Moraes A., Silvestre A., Martinho G., Siqueira N., Genzini T. Liver Transplantation with or without Left Renal Vein Ligation: Comparative Study of 105 Cases Am J Transplant. 2017;17 (suppl 3).

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