Renoportal Anastomosis during Liver Transplantation in Patients with Portal Vein Thrombosis: First Long-Term Results from a Multicenter Study.

Abstract

OBJECTIVE\nTo evaluate the short- and long-term outcomes of renoportal anastomosis (RPA) in a large multicentric series.\n\n\nSUMMARY BACKGROUND\nThe current knowledge on RPA for portal reconstruction during liver transplantation (LT) in patients with diffuse portal vein thrombosis (PVT) and a large splenorenal shunt (SRS) is poor and limited to case reports and small case series.\n\n\nMETHODS\nAll consecutive LTs with RPA performed in 5 centers between 1998 and 2020 were included. RPA was physiological provided it drained the splanchnic venous return through a large SRS (≥1\u200acm diameter). Complications of portal hypertension (PHT), long-term RPA patency, and patient and graft survival were assessed. RPA success was achieved provided the 3 following criteria were all fulfilled: patients were alive with patent RPA and without clinical PHT.\n\n\nRESULTS\nRPA was attempted and feasible in 57 consecutive patients and was physiological in 51 patients (89.5%). Ninety-day mortality occurred in 5 (8.5%) patients, and PHT-related complications occurred in 42.9% of patients. With a median follow-up of 63\u200amonths, the 1-, 3- and 5-year patient and graft survival rates were 87%, 83%, and 76% and 82%, 80%, and 73%, respectively. The primary and primary-assisted patency rates at 5\u200ayears were 84.5% and 94.3%, respectively. Success was achieved in 90% (27/30) of patients with a follow-up ≥ 5\u200ayears.\n\n\nCONCLUSIONS\nDespite a high rate of PHT-related complications, excellent long-term patient and graft survival could be achieved. RPA could be considered successful in the vast majority of patients. The expanded use of RPA is warranted.