Renoportal Anastomosis and Its Complications: A Complex Case Report

Area of Science:

• Hepatobiliary surgery
• Transplant surgery
• Vascular surgery

Background:

• Renoportal anastomosis (RPA) is utilized for complex portal vein thrombosis with splenorenal shunts.
• Liver transplantation (LT) is a critical treatment for end-stage liver disease.
• Portal vein thrombosis (PVT) poses significant challenges in LT recipients.

Observation:

• A patient with cirrhosis and hepatocellular carcinoma underwent LT with RPA for severe PVT and shunts.
• The procedure involved iliac vein graft interposition and inferior mesenteric vein ligation.
• Post-operative complications included graft dysfunction, acute kidney injury, re-thrombosis, fistula formation, ascites, bleeding, and peritonitis.

Findings:

• Despite initial portal flow restoration, mesenteric root compression led to decreased flow.
• Multiple interventions were required to manage graft and vascular complications.
• The patient ultimately developed sepsis and multiorgan failure, succumbing on postoperative day 70.

Implications:

• RPA, while effective for complex PVT, carries a high risk of serious complications.
• Careful surgical technique and vigilant post-operative monitoring are crucial.
• This case underscores the technical challenges and potential adverse outcomes associated with RPA in LT.