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Invited Critique |

Liver Transplantation With Renoportal Anastomosis After Distal Splenorenal Shunt—Invited Critique

J. Michael Henderson, MD
Arch Surg. 2000;135(12):1404. doi:10.1001/archsurg.135.12.1404.
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This article presents a novel approach to portal revascularization for liver transplantation after DSRS. The authors have identified 5 patients who developed significant collateral vessels from their high-pressure mesenteric venous circulation across to the low-pressure splenic vein, the shunt, to the left renal vein. In these patients, the progression of cirrhosis with increased obstruction to portal flow led to the total reversal of portal flow and to the mesenteric flow being siphoned to the shunt. The authors appropriately recognized this technique as an alternative means of revascularization of the liver transplant. The choice for patients such as these is either to dissect down to the superior mesenteric vein and place a jump graft to revascularize the new liver, or to use the technique described. In the latter situation, dissection of the superior mesenteric vein can be difficult because of significant large collateral vessels from this vein into the pancreas and along the mesocolon toward the low-pressure DSRS. The alternative is to ignore the superior mesenteric vein dissection and simply isolate the final common outflow of all these collateral vessels (ie, the left renal vein).

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