Liver Transplant With Double Portal Anastomose: A Case Report

Area of Science:

• Hepatobiliary Surgery
• Transplant Surgery
• Vascular Surgery

Background:

• Reno-portal reconstruction is a surgical option for liver transplant patients with complete portal vein thrombosis.
• This technique aims to restore adequate portal blood flow, especially when collaterals or portosystemic shunts are present.

Observation:

• A 58-year-old man with liver cirrhosis, esophageal varices, and portal vein thrombosis underwent evaluation for liver transplant.
• Preoperative imaging revealed significant collateral circulation and a hypoplastic portal vein.
• Intraoperative findings included type II portal thrombosis and a large inferior mesenteric vein (IMV) to iliac vein shunt.

Findings:

• Eversion thrombectomy successfully managed the portal thrombosis.
• Initial attempts with a temporary portocaval shunt provided minimal portal vein flow.
• A subsequent reno-portal anastomosis achieved 600 cc/min portal flow.
• An additional end-to-side portoportal anastomosis augmented flow to 1300 cc/min with low resistance.

Implications:

• A double anastomosis technique, combining portoportal and reno-portal reconstruction, is a valuable strategy for managing insufficient portal flow in liver transplant recipients.
• This approach can overcome challenges posed by hypoplastic portal veins and complex thrombosis patterns.
• Successful restoration of portal flow is critical for graft viability and patient outcomes in liver transplantation.