Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation

BackgroundA large spontaneous splenorenal shunt (SRS) will greatly impact portal inflow to the graft during liver transplantation (LT). Direct ligation of a large SRS is an uncommon surgical procedure and the hemodynamic consequences of this procedure are unknown. MethodsIn this retrospective study, we described our technique for direct ligation of a large SRS and the consequent hemodynamic changes during LT. 3-Dimensional computed tomography and Doppler ultrasonography were used to evaluate SRS and portal vein blood flow volume (PFV). ResultsA total of 22 recipients had large SRS including 13 with PFV <85 ml/min/100 g (ligation group) and 9 with PFV >= 85 ml/min/100 g (no ligation group). The diameter of SRS was significantly larger in the ligation group than in the non-ligation group (22.92 +/- 4.18 vs. 16.24 +/- 3.60 mm; p = 0.0009). In all ligation patients, the SRS was easily identified and isolated, it was located just below the distal pancreas and beside the inferior mesenteric vein. PV flow increased significantly from 68.74 +/- 8.77 to 116.80 +/- 16.50 ml/min/100 g (p < 0.0001) after ligation; this was followed by a reduction in peak systolic velocity of the hepatic artery from 58.17 +/- 14.87 to 46.67 +/- 13.28 cm/s (p = 0.0013). ConclusionsDirect ligation of large SRS was an effective and safe surgical procedure to overcome the problem of portal hypoperfusion during LT.