Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation
BackgroundA large spontaneous splenorenal shunt (SRS) will greatly impact portal inflow to the graft during liver transplantation (LT). Direct ligation of a large SRS is an uncommon surgical procedure and the hemodynamic consequences of this procedure are unknown.MethodsIn this retrospective study,...
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.916327/full |
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| author | Guangshun Chen Guangshun Chen Qiang Li Qiang Li Zhongqiang Zhang Zhongqiang Zhang Bin Xie Bin Xie Jing Luo Jing Luo Zhongzhou Si Zhongzhou Si Jiequn Li Jiequn Li |
| author_facet | Guangshun Chen Guangshun Chen Qiang Li Qiang Li Zhongqiang Zhang Zhongqiang Zhang Bin Xie Bin Xie Jing Luo Jing Luo Zhongzhou Si Zhongzhou Si Jiequn Li Jiequn Li |
| author_sort | Guangshun Chen |
| collection | DOAJ |
| description | BackgroundA large spontaneous splenorenal shunt (SRS) will greatly impact portal inflow to the graft during liver transplantation (LT). Direct ligation of a large SRS is an uncommon surgical procedure and the hemodynamic consequences of this procedure are unknown.MethodsIn this retrospective study, we described our technique for direct ligation of a large SRS and the consequent hemodynamic changes during LT. 3-Dimensional computed tomography and Doppler ultrasonography were used to evaluate SRS and portal vein blood flow volume (PFV).ResultsA total of 22 recipients had large SRS including 13 with PFV <85 ml/min/100 g (ligation group) and 9 with PFV ≥85 ml/min/100 g (no ligation group). The diameter of SRS was significantly larger in the ligation group than in the non-ligation group (22.92 ± 4.18 vs. 16.24 ± 3.60 mm; p = 0.0009). In all ligation patients, the SRS was easily identified and isolated, it was located just below the distal pancreas and beside the inferior mesenteric vein. PV flow increased significantly from 68.74 ± 8.77 to 116.80 ± 16.50 ml/min/100 g (p < 0.0001) after ligation; this was followed by a reduction in peak systolic velocity of the hepatic artery from 58.17 ± 14.87 to 46.67 ± 13.28 cm/s (p = 0.0013).ConclusionsDirect ligation of large SRS was an effective and safe surgical procedure to overcome the problem of portal hypoperfusion during LT. |
| first_indexed | 2024-04-11T19:53:06Z |
| format | Article |
| id | doaj.art-e865e4c293604386af6f2ead9ec4afef |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-11T19:53:06Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-e865e4c293604386af6f2ead9ec4afef2022-12-22T04:06:14ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-10-01910.3389/fsurg.2022.916327916327Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantationGuangshun Chen0Guangshun Chen1Qiang Li2Qiang Li3Zhongqiang Zhang4Zhongqiang Zhang5Bin Xie6Bin Xie7Jing Luo8Jing Luo9Zhongzhou Si10Zhongzhou Si11Jiequn Li12Jiequn Li13Department of Liver Transplant, The Second Xiangya Hospital of Central South University, Changsha, ChinaTransplant Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, ChinaDepartment of Liver Transplant, The Second Xiangya Hospital of Central South University, Changsha, ChinaTransplant Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, ChinaDepartment of Liver Transplant, The Second Xiangya Hospital of Central South University, Changsha, ChinaTransplant Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, ChinaDepartment of Liver Transplant, The Second Xiangya Hospital of Central South University, Changsha, ChinaTransplant Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, ChinaDepartment of Liver Transplant, The Second Xiangya Hospital of Central South University, Changsha, ChinaTransplant Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, ChinaDepartment of Liver Transplant, The Second Xiangya Hospital of Central South University, Changsha, ChinaTransplant Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, ChinaDepartment of Liver Transplant, The Second Xiangya Hospital of Central South University, Changsha, ChinaTransplant Medical Research Center, The Second Xiangya Hospital of Central South University, Changsha, ChinaBackgroundA large spontaneous splenorenal shunt (SRS) will greatly impact portal inflow to the graft during liver transplantation (LT). Direct ligation of a large SRS is an uncommon surgical procedure and the hemodynamic consequences of this procedure are unknown.MethodsIn this retrospective study, we described our technique for direct ligation of a large SRS and the consequent hemodynamic changes during LT. 3-Dimensional computed tomography and Doppler ultrasonography were used to evaluate SRS and portal vein blood flow volume (PFV).ResultsA total of 22 recipients had large SRS including 13 with PFV <85 ml/min/100 g (ligation group) and 9 with PFV ≥85 ml/min/100 g (no ligation group). The diameter of SRS was significantly larger in the ligation group than in the non-ligation group (22.92 ± 4.18 vs. 16.24 ± 3.60 mm; p = 0.0009). In all ligation patients, the SRS was easily identified and isolated, it was located just below the distal pancreas and beside the inferior mesenteric vein. PV flow increased significantly from 68.74 ± 8.77 to 116.80 ± 16.50 ml/min/100 g (p < 0.0001) after ligation; this was followed by a reduction in peak systolic velocity of the hepatic artery from 58.17 ± 14.87 to 46.67 ± 13.28 cm/s (p = 0.0013).ConclusionsDirect ligation of large SRS was an effective and safe surgical procedure to overcome the problem of portal hypoperfusion during LT.https://www.frontiersin.org/articles/10.3389/fsurg.2022.916327/fullportal blood flow volumeliver transplantationhemodynamic consequencesspontaneous splenorenal shuntsportal vein thrombus |
| spellingShingle | Guangshun Chen Guangshun Chen Qiang Li Qiang Li Zhongqiang Zhang Zhongqiang Zhang Bin Xie Bin Xie Jing Luo Jing Luo Zhongzhou Si Zhongzhou Si Jiequn Li Jiequn Li Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation Frontiers in Surgery portal blood flow volume liver transplantation hemodynamic consequences spontaneous splenorenal shunts portal vein thrombus |
| title | Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation |
| title_full | Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation |
| title_fullStr | Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation |
| title_full_unstemmed | Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation |
| title_short | Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation |
| title_sort | hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation |
| topic | portal blood flow volume liver transplantation hemodynamic consequences spontaneous splenorenal shunts portal vein thrombus |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.916327/full |
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