Ligation of Left Renal Vein as a Salvage Procedure for Splenorenal Shunt After Living Donor Liver Transplantation: A Case Report

We describe a case of recovered portal flow by ligation of the left renal vein (LRV) as a salvage procedure for a spontaneous splenorenal shunt (SRS) occurring the next day after right liver living donor transplantation (LDLT). Doppler ultrasonography showed normal graft portal venous flow immediately after LDLT, but nearly total diversion of portal flow into the existing splenorenal shunt was observed on the next day. Portal flow normalized after ligation of the LRV by relaparotomy. The patient recovered fully without complication and was discharged on the 17th postoperative day. He remains well at 14 months after the operation, returning to his previous occupation. This case was neither associated with acute rejection nor with small-for-size graft, which may increase intrahepatic vascular resistance, causing portal flow steal through shunts. Even though patients with preoperative SRS show normal portal flow immediately after transplantation, close monitoring is necessary for a possible decrease or loss of portal flow. If portal flow becomes insufficient, ligation of LRV as a salvage procedure is an important option that can be considered even after transplantation.