Dilation of the left renal vein: an indicator of spontaneous splenorenal shunt in chronic liver disease patients.

Abstract

Objectives: Spontaneous splenorenal shunts (SSS) in chronic liver disease (CLD) impact liver perfusion and prognosis post-liver transplantation. This study aims to identify radiological findings that predict the presence of SSS in CLD patients and to examine the relationship between SSS and left renal vein diameter.

Methods: A retrospective study was conducted on 150 adult patients evaluated for liver transplants from June 2018 to April 2021. The study groups included healthy controls (Group 1), CLD patients without SSS (Group 2), and those with SSS (Group 3). Multidetector CT angiography was used to measure the diameters of renal veins, portal vein, spleen size, and SSS.

Results: Significant differences were found between the groups for spleen size, splenic vein diameter, portal vein diameter, left renal vein diameter, and renal vein diameter difference, except for the right renal vein diameter. A left renal vein diameter of 10.5 mm or greater and both renal veins diameter difference of 0.5 mm or more favouring the left showed good diagnostic performance for predicting SSS, with area under the curve values of 0.828 and 0.833, respectively.

Conclusion: Dilation of the left renal vein and a greater diameter difference between renal veins favouring the left are strong indicators of SSS in CLD patients. These findings can aid in pre-transplant assessments and potentially improve post-transplant outcomes.

Advances in knowledge: This study establishes that an increased diameter of the left renal vein and a greater diameter difference between renal veins are reliable radiological indicators for predicting the presence of SSS in CLD patients.