Department of Surgery, Faculty of Medicine, Kyoto University, Kawara-cho 54, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Transpl Int. 2009 Dec;22(12):1189-92. doi: 10.1111/j.1432-2277.2009.00928.x. Epub 2009 Jul 20.
Adult-to-adult living donor liver transplantation (LDLT) has become an established treatment option around the world. However, small-for-size graft syndrome remains one of the most serious complications affecting transplant outcomes. Excessive portal hypertension and overperfusion have been shown to play a causative role in this graft injury. Recently, portal hypertension per se has been considered detrimental to graft function, and thus to be avoided for successful outcomes after LDLT. We constructed a mesorenal shunt with anastomosis of the inferior mesenteric vein and left renal vein in the case of an LDLT recipient who showed high portal vein pressure after graft reperfusion. The inferior mesenteric vein is close to the left renal vein, and the anastomosis was obtained with relative ease. The shunt was effective in decreasing portal vein pressure, and postoperative graft function was satisfactory. This new method represents an option for attenuating portal hypertension when elevated portal vein pressure is observed in adult LDLT after graft reperfusion.
成人对成人活体肝移植（LDLT）已成为全球范围内一种成熟的治疗选择。然而，小肝综合征仍然是影响移植结果的最严重并发症之一。门静脉高压和过度灌注已被证明在这种移植物损伤中起因果作用。最近，门静脉高压本身被认为对移植物功能有害，因此，为了 LDLT 后的成功结果，应避免门静脉高压。我们在一名 LDLT 受者中构建了一个肠系膜-肾分流术，吻合肠系膜下静脉和左肾静脉，该受者在移植物再灌注后表现出门静脉高压。肠系膜下静脉靠近左肾静脉，吻合相对容易获得。分流术有效地降低了门静脉压力，术后移植物功能令人满意。当在成人 LDLT 后移植物再灌注时观察到门静脉高压时，这种新方法代表了一种减轻门静脉高压的选择。
