*Purpose: Diffuse splanchnic venous thrombosis (DSVT) remains a serious challenge for the liver transplant (LT) surgeon, despite ongoing advances in surgical techniques. Reno-portal anastomosis (RPA) has previously been reported as a valid option for the management of patients with DSVT during LT. The aim of this study was to compare the associated short and long-term outcomes in a cohort of patients with DSVT who underwent RPA during LT to those of a matched population of patients undergoing conventional LT without DSVT.

*Methods: A propensity score (PS) model was used to compare patients with DSVT to a cohort of patients without DSVT. The following variables were considered as covariates: age, sex, year of LT, Model for End-Stage Liver Disease score, donor risk index, renal function pre-LT (including estimated glomerular filtration rate (eGFR), presence of chronic kidney disease, and acute kidney injury), and liver weight. A 1:2 matching model with replacement was utilized. The analysis was performed over 5 years of follow-up.

*Results: 1250 patients underwent LT between January 2005 and December 2017 at our quaternary referral transplant center. 16 patients had DSVT that required RPA (using a venous jump graft) at the time of LT; all were noted to have concurrent spleno-renal shunt (SRS). The 16 patients with DSVT were compared to 32 matched patients without thrombosis (NDSVT group). There were no significant differences in operative blood loss, transfusion requirements, operative time, cold ischemia time, warm ischemia time, intraoperative flow measurements, ICU or hospital length of stay between the 2 groups. Primary graft non-function was not observed in either group. Some postoperative complications are summarized in Table 1. All cases of post-operative ascites resolved within 3 months of LT. The eGFR decreased by 23% in the DSVT group and by 21.5% in the NDSVT group at 5 years (p 0.3). Survival at 5 years was similar for patients with DSVT and NDVST (93.7% vs 96.8%, p=0.9).

*Conclusions: RPA is an established technique in the management of patients with DSVT during LT, with comparable outcomes to patients without thrombosis. Our report is the first to demonstrate similar long-term renal function in patients undergoing RPA for DSVT when compared to patients undergoing conventional LT. We suggest that RPA be considered in patients with DSVT with and without SRS as a method by which to negate alternative approaches to DSVT, such as cavoportal hemitransposition or multivisceral transplant.

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