Background: Splenorenal shunt (SRS) is a type of portosystemic shunt that develops frequently in the setting of chronic portal hypertension and cirrhosis. It remains controversial if intervention for SRS peri-liver transplantation (LT) leads to outcome benefit. We aimed to assess the natural history of SRS and to compare the post-LT outcome between the patients with SRS who received peri-transplant intervention versus those who did not.

Methods: We conducted a retrospective chart review of patients who received LT at our center between 2012 and 2017. All patients provided written consent for research participation. Primary outcomes of interest included intraoperative transfusion requirement, length of stay, post-op acute kidney injury, portal vein thrombosis, thrombocytopenia and 1-year graft and patient survival.

Results: 50 out of 268 (18.6%) LT patients were found to have large SRS before transplant and 45 of them had all outcome data available. Nine out of 45 (20%) patients received intervention for SRS including pre-transplant BRTO (n=5), intraoperative ligation of the left renal vein (n=3) and intraoperative direct shunt ligation (n=1). There was no difference in age, gender, MELD score or the etiology of the end stage liver disease between the intervention and the non-intervention group. There was no difference in transfusion requirements, hospital length of stay, 3-mo platelet count and creatinine level, portal vein thrombosis, 1-yr graft and patient survival between the two groups. Compared to the non-intervention group, the rate of post-operative acute kidney injury was significantly lower in patients in the intervention group (0 cases in intervention group vs 12 cases (20%) in the non-intervention group; Odd ratios 0.73; 95% CI: 0.59-0.90). Patients with no intervention (n=36) were followed after LT. 27 of them had post-transplant imaging and SRS completely resolved in 4 patients (15%), and persisted in the rest.

Conclusions: The large majority of SRS persisted post LT. Peri-transplant intervention for SRS did not affect the post-transplant clinical outcomes except for the reduction of post-transplant acute kidney injury.

CITATION INFORMATION: Wang J., Nickkholgh A., Shahbazov R., Pelletier S., Maluf D. Intervention for Splenorenal Shunt May Decrease the Incidence of Post-Liver Transplant Acute Kidney Injury Am J Transplant. 2017;17 (suppl 3).

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