Left Renal Vein Ligation in Patients With Liver Cirrhosis and Spontaneous Splenorenal Shunt in Liver Transplantation

Abstract

Adequate hepatopetal portal venous inflow is a prerequisite for graft viability and functional recovery after liver transplantation. In some recipients, large portosystemic collaterals persist despite transplantation, diverting portal flow and predisposing to portal steal and subsequent graft dysfunction. Spontaneous splenorenal shunts (SSS) represent a particularly challenging manifestation of this phenomenon. Several surgical strategies have been proposed to restore effective portal inflow, including splenectomy, shunt ligation, and left renal vein ligation (LRVL). Compared with alternative approaches, LRVL is technically easier and less invasive, making it an attractive adjunctive maneuver. However, its optimal indications and long-term clinical consequences—particularly with respect to graft performance and renal function—remain incompletely defined. Although prior reports suggest that LRVL can attenuate portosystemic shunting and enhance hepatopetal portal flow, the existing evidence is heterogeneous and largely derived from small, single-center series. In this study, we compared outcomes among liver transplant recipients with SSS managed with or without LRVL, with a focus on perioperative outcomes, graft-related complications, renal and liver function, and survival, in order to better delineate the clinical role of LRVL. Donors were not prisoners, coerced, or paid.