1 AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, F-94800, France. 2 Inserm, Unité 1193, Villejuif, F-94800, France. 3 Univ Paris-Sud, UMR-S 1193, Villejuif, F-94800, France. 4 Inserm, Unité 776, Villejuif, F-94800, France. 5 Univ Paris-Sud, UMR-S 776, Villejuif, F-94800, France. 6 DHU Hepatinov, Villejuif, F-94800, France.
Transplantation. 2015 Dec;99(12):2576-85. doi: 10.1097/TP.0000000000000766.
Management of portal inflow to the graft in patients with spontaneous splenorenal shunts (SRS) is a matter of concern especially in case of large varices (more than 1 cm). In case of portal vein (PV) thrombosis (PVT), renoportal anastomosis (RPA) directly diverts the splanchnic and renal venous blood assuring a good portal inflow to the graft. Disconnection of the portacaval shunt by left renal vein ligation (LRVL) is another option but requires a patent PV. The indication of primary RPA rather than LRVL in patients with small native PV, especially in case of large graft, should be questioned in these complex cases of liver transplantation.
From 1998 to 2012, 17 patients with RPA and 15 patients with LRVL were transplanted in our center. We compared these 2 techniques for short- and long-term results.
The rate of preliver transplantation PVT (76% vs 27%) and graft weight (1538 ± 383 g vs 1293 ± 216 g) was significantly higher in the RPA group. Renoportal anastomosis was performed in 4 cases of small but patent PV. Three-month mortality, morbidity, and massive ascitis were similar. No patient was retransplanted. One year after transplantation, PV diameter was still larger in RPA group. Three-year survival was similar (RPA: 79% vs LRVL: 53%, P = 0.1).
In cirrhotic patients transplanted with large splenorenal shunts, RPA and LRVL reach similar survivals. In case of complete PVT and failure of thrombectomy, the RPA offers satisfactory long-term results.
对于自发性脾肾分流（SRS）患者，门静脉流入到移植物的管理是一个关注点，尤其是在存在大的静脉曲张（超过 1 厘米）的情况下。在门静脉（PV）血栓形成（PVT）的情况下，肾门静脉吻合术（RPA）直接使内脏和肾静脉血液分流，确保了移植物的良好门静脉流入。通过左肾静脉结扎（LRVL）断开门腔分流是另一种选择，但需要有通畅的 PV。在这些复杂的肝移植病例中，对于小的固有 PV，特别是在大的移植物的情况下，应质疑原发性 RPA 而非 LRVL 的适应证。
1998 年至 2012 年，我们中心共进行了 17 例 RPA 和 15 例 LRVL 移植。我们比较了这两种技术的短期和长期结果。
RPA 组患者在肝移植前的 PVT 发生率（76%对 27%）和移植物重量（1538±383g 对 1293±216g）显著更高。在 4 例小但通畅的 PV 中进行了 RPA。3 个月死亡率、发病率和大量腹水相似。没有患者需要再次移植。移植后 1 年，RPA 组的 PV 直径仍较大。3 年生存率相似（RPA：79%对 LRVL：53%，P=0.1）。
在移植大的脾肾分流的肝硬化患者中，RPA 和 LRVL 达到相似的存活率。在完全 PVT 和血栓切除术失败的情况下，RPA 提供了令人满意的长期结果。
