Living-donor liver transplantation with renoportal anastomosis for patients with large spontaneous splenorenal shunts
Living-donor liver transplantation with renoportal anastomosis for patients with large spontaneous splenorenal shunts
复制标题
DOI：
10.1097/01.tp.0000185087.93572.1d
复制
发表时间：
2005-12-27
期刊：
影响因子：
6.2
通讯作者：
Monden, M
中科院分区：
文献类型：
--
作者：
Marubashi, S;Dono, K;Monden, M
背景资料。终末期肝病常伴有大量自发性脾肾分流和门静脉血栓形成。活体肝移植自发性脾肾分流的肾门吻合术是治疗这些患者的解决方案之一。然而，肝移植后的远期结局、门静脉血流动力学以及改变肾静脉引流的效果尚不清楚。在1999-2004年间，我们进行了三次活体肝移植联合肾门静脉吻合治疗自发性脾肾分流。然后，我们通过短期和长期的随访来评估这一手术的结果，其中包括术后移植肾功能、肾功能、放射学图像和门静脉血流动力学的检查。所有三名接受活体肝移植肾门静脉吻合的患者均存活，移植物功能正常，肾门静脉吻合通畅。门静脉血流动力学与传统活体肝移植受者相似，对同种异体肝移植功能无不良影响。2例术后左肾功能恢复正常，1例左肾功能轻度受损，但临床上可忽略不计。活体肝移植联合肾门静脉吻合治疗终末期肝病患者的自发性脾肾分流是一种安全、挽救生命的技术，应作为脾肾分流患者的一种治疗选择。
Background. End-stage liver disease is often accompanied by large spontaneous splenorenal shunts and thrombosed portal vein. Renoportal anastomosis for spontaneous splenorenal shunts in living-donor liver transplantations is one of the solutions for the treatment of these patients. However, the long-term outcome, portal venous hemodynamics after liver transplantation, and the effects of altering the renal venous drainage remained unknown.Methods. We performed three living-donor liver transplantations with renoportal anastomosis for the treatment of spontaneous splenorenal shunts between 1999 and 2004. We then evaluated the outcome of this procedure using short- and long-term follow-ups in which the postoperative graft function, renal function, radiological images and portal hemodynamics were examined.Results. All three patients who underwent a living-donor liver transplantation with renoportal anastomosis are alive with normal graft function and a patent renoportal anastomosis. The portal hemodynamics were similar to those in conventional living-donor liver transplantation recipients, and had no harmful effect on allograft function. Left renal function returned to normal after the temporal impairment in two cases, and remained slightly impaired in one, although it was negligible clinically.Conclusions. Living-donor liver transplantation with renoportal anastomosis for the treatment of spontaneous splenorenal shunts in patients with end-stage liver disease is a life-saving and safe technique and should be discussed as a treatment option for patients with splenorenal shunts.