Left Renal Vein Ligation for Management of Portal Hypoperfusion in Liver Transplantation.
Henry Ford Transplant Institute, Henry Ford Hospital, Detroit, MI.
Meeting: 2016 American Transplant Congress
Abstract number: C222
Keywords: Portal veins
Session Information
Session Name: Poster Session C: Liver Transplantation Complications and Other Considerations
Session Type: Poster Session
Date: Monday, June 13, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Intro: In orthotopic liver transplant (OLT), low portal venous flow (PVF) is an independent risk factor for 1-year mortality. Ligation of existing portosystemic shunts is recommended. We describe our institutional experience with left renal vein (LRV) ligation to augment low PVF via spontaneous splenorenal shunts.
Methods: We routinely measure intraoperative PVF following reperfusion. PVF<800mL/min leads to evaluation for intervention. If the portal vein anastomosis is normal, and ligation of spontaneous portosystemic shunts is unsuccessful, we evaluate for spontaneous LRV collaterals. If present, we proceed with temporary LRV occlusion. Augmentation results in ligation, otherwise alternative methods are pursued. We reviewed all deceased-donor OLTs performed at Henry Ford Hospital from 3/1/2009 to 9/1/2015.
Results: Eight cases describing LRV ligation were identified. PVF increased from 550 to 1380 mL/min. Two patients required post-transplant hemodialysis (HD). Patient #6 underwent reoperation for removal of the tie used to ligate the LRV due to worsening renal function, however HD was required due to lack of improvement. Patient #2 did not have improvement in PVF with ligation, so the portal vein was arterialized with donor gastroduodenal artery and improved to 1200mL/min. Table 1 and 2 summarize the patients reviewed.
| Patient | Age | Diagnosis | True MELD | PVF Pre-ligation (mL/min) | PVF Post-ligation (mL/min) | Hepatic Artery Flow (mL/min) |
| 1 | 43 | Hepatitis C | 19 | 200 | 1280 | 420 |
| 2 | 59 | EtOH, HCC | 15 | 450 | 600 | 500 |
| 3 | 68 | EtOH | 12 | 500 | 1500 | 215 |
| 4 | 65 | EtOH, HCC | 9 | 540 | 1180 | 205 |
| 5 | 61 | NASH | 24 | 600 | 1600 | 550 |
| 6 | 34 | Hepatitis C | 26 | 750 | 1800 | 265 |
| 7 | 62 | Hepatitis C | 21 | 800 | 1500 | 570 |
| 8 | 63 | Hepatitis C | 15 | Not Documented | 1560 | 500 |
| Patient | Creatinine Pre-Op | Creatinine 24 hour | Creatinine 72 hour | Creatinine 2 week | HD |
| 1 | 0.8 | 1.4 | 0.9 | 1.1 | No |
| 2 | 0.9 | 1.3 | 0.5 | 2.3 | Yes |
| 3 | 1.1 | 0.9 | 0.7 | 0.5 | No |
| 4 | 0.67 | 0.7 | 0.64 | 0.67 | No |
| 5 | 1.1 | 1.7 | 1 | 1.3 | No |
| 6 | 0.8 | 2.7 | 1.4 | 2.7 | Yes |
| 7 | 1.07 | 1.8 | 2.21 | 1.38 | No |
| 8 | 0.69 | 1.52 | 1.24 | 1.89 | No |
Conclusion: Selective LRV ligation in patients with low PVF during OLT is a viable option for augmentation if ligation of spontaneous portosystemic shunts is not beneficial.
CITATION INFORMATION: Putchakayala K, Kane W, Takahashi K, Rizzari M, Yoshida A, Abouljoud M. Left Renal Vein Ligation for Management of Portal Hypoperfusion in Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Putchakayala K, Kane W, Takahashi K, Rizzari M, Yoshida A, Abouljoud M. Left Renal Vein Ligation for Management of Portal Hypoperfusion in Liver Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/left-renal-vein-ligation-for-management-of-portal-hypoperfusion-in-liver-transplantation/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress