{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T14:58:38Z","timestamp":1784991518742,"version":"3.55.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2017,6,20]],"date-time":"2017-06-20T00:00:00Z","timestamp":1497916800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1"},{"start":{"date-parts":[[2017,6,20]],"date-time":"2017-06-20T00:00:00Z","timestamp":1497916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:p>Patients with large spontaneous splenorenal shunts (SRSs) prove challenging during liver transplantation (LT), regardless of organizing portal vein (PV) thrombosis. Here, we detail the clinical outcomes of 26 patients who underwent direct ligation of large SRSs during LT. Direct ligation of large SRS was applied in poor portal flow during LT. We performed temporary test clamping of the SRS before direct ligation and applied PV pressure monitoring in patients who showed signs of portal hypertension, such as bowel edema. We retrospectively reviewed and evaluated their clinical outcomes. Among 843 patients who underwent LT between 2010 and 2015, 26 (3.1%) underwent direct ligation of SRS without any intraoperative event. Mean preoperative Model for End\u2010Stage Liver Disease score was 16.7\u2009\u00b1\u20099.0. The main PV diameter on preoperative computed tomography was 8.3\u2009\u00b1\u20093.4\u2009mm (range, 3.0\u201014.0\u2009mm). SRS was easily identified at just below the distal pancreas and beside the inferior mesenteric vein in all patients. Accompanying PV thrombectomy was done in 42.3% of patients. Among 26 patients, massive and prolonged ascites was evident in 15.4% (n\u2009=\u20094) postoperatively. They were all living donor LT recipients with a small PV diameter (4.0\u20106.7\u2009mm). Except for 1 patient who underwent splenic artery embolization, ascites was tolerable and well controlled by conservative management. There was a 7.7% rate of major complications related to direct ligation, including reoperation due to combined ligation of SRS along with a left renal vein at the confluence. Except for 1 hospital mortality due to sepsis, 25 patients (96.2%) are alive with no evidence of further PV complications. In conclusion, direct ligation of large SRS during LT is a safe and feasible method to overcome the effects of a large SRS. <jats:italic toggle=\"yes\">Liver Transplantation 23 899\u2013906 2017<\/jats:italic> AASLD.<\/jats:p>","DOI":"10.1002\/lt.24783","type":"journal-article","created":{"date-parts":[[2017,5,8]],"date-time":"2017-05-08T09:07:51Z","timestamp":1494234471000},"page":"899-906","source":"Crossref","is-referenced-by-count":21,"title":["Tips and pitfalls in direct ligation of large spontaneous splenorenal shunt during liver transplantation"],"prefix":"10.1097","volume":"23","author":[{"given":"Hyeyoung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Chul","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwang\u2010Woong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam\u2010Joon","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hae Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2408-7086","authenticated-orcid":false,"given":"YoungRok","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongkyu","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyo\u2010Sin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suk Kyun","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9586-8747","authenticated-orcid":false,"given":"Sung Woo","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung\u2010Suk","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Surgery,Seoul National University College of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,6,20]]},"reference":[{"key":"lt24783-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1111\/j.1600-6143.2011.03578.x","article-title":"Left renal vein ligation: a technique to mitigate low portal flow from splenic vein siphon during liver transplantation","volume":"11","year":"2011","journal-title":"Am J Transplant"},{"key":"lt24783-bib-0002-20240115","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/01.tp.0000198122.15235.a7","article-title":"Optimal portal venous circulation for liver graft function after living\u2010donor liver transplantation","volume":"81","year":"2006","journal-title":"Transplantation"},{"key":"lt24783-bib-0003-20240115","doi-asserted-by":"crossref","first-page":"2576","DOI":"10.1097\/TP.0000000000000766","article-title":"Spontaneous splenorenal shunt in liver transplantation: results of left renal vein ligation versus renoportal anastomosis","volume":"99","year":"2015","journal-title":"Transplantation"},{"key":"lt24783-bib-0004-20240115","doi-asserted-by":"crossref","first-page":"475","DOI":"10.6002\/ect.2011.0201","article-title":"Perioperative management of spontaneous splenorenal shunts in orthotopic liver transplant patients","volume":"10","year":"2012","journal-title":"Exp Clin Transplant"},{"key":"lt24783-bib-0005-20240115","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1007\/s00268-009-0314-x","article-title":"Effect of liver transplantation on spleen size, collateral veins, and platelet counts","volume":"34","year":"2010","journal-title":"World J Surg"},{"key":"lt24783-bib-0006-20240115","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1097\/TP.0b013e318196340d","article-title":"Postshunt hepatic encephalopathy in liver transplant recipients","volume":"87","year":"2009","journal-title":"Transplantation"},{"key":"lt24783-bib-0007-20240115","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/lt.500050114","article-title":"Liver transplantation in patients with splenorenal shunts: intraoperative flow measurements to indicate shunt occlusion","volume":"5","year":"1999","journal-title":"Liver Transpl Surg"},{"key":"lt24783-bib-0008-20240115","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1002\/lt.23636","article-title":"Left renal vein ligation during liver transplantation in a recipient with a single kidney","volume":"19","year":"2013","journal-title":"Liver Transpl"},{"key":"lt24783-bib-0009-20240115","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1016\/j.transproceed.2015.06.019","article-title":"Surgical management of large spontaneous portosystemic splenorenal shunts during liver transplantation: splenectomy or left renal vein ligation?","volume":"47","year":"2015","journal-title":"Transplant Proc"},{"key":"lt24783-bib-0010-20240115","doi-asserted-by":"crossref","first-page":"4243","DOI":"10.1016\/j.transproceed.2009.08.054","article-title":"Ligation of left renal vein as a salvage procedure for splenorenal shunt after living donor liver transplantation: a case report","volume":"41","year":"2009","journal-title":"Transplant Proc"},{"key":"lt24783-bib-0011-20240115","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/lt.22304","article-title":"Hemodynamic consequences of spontaneous splenorenal shunts in deceased donor liver transplantation","volume":"17","year":"2011","journal-title":"Liver 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shunt","volume":"135","year":"2000","journal-title":"Arch Surg"},{"key":"lt24783-bib-0018-20240115","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1034\/j.1399-0012.2000.140309.x","article-title":"Venous complications after orthotopic liver transplantation","volume":"14","year":"2000","journal-title":"Clin Transplant"},{"key":"lt24783-bib-0019-20240115","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien\u2010Dindo classification of surgical complications: five\u2010year experience","volume":"250","year":"2009","journal-title":"Ann Surg"},{"key":"lt24783-bib-0020-20240115","first-page":"156","article-title":"The outcome of living donor liver transplantation with prior spontaneous large portasystemic shunts","volume":"21","year":"2008","journal-title":"Transpl Int"},{"key":"lt24783-bib-0021-20240115","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s11605-012-2006-3","article-title":"New surgical 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case","volume":"39","year":"2009","journal-title":"Surg Today"},{"key":"lt24783-bib-0028-20240115","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s00595-005-3136-y","article-title":"Management of major portosystemic shunting in small\u2010for\u2010size adult living\u2010related donor liver transplantation with a left\u2010sided graft liver","volume":"36","year":"2006","journal-title":"Surg Today"},{"key":"lt24783-bib-0029-20240115","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1007\/s00595-013-0535-3","article-title":"Balloon\u2010occluded retrograde transvenous obliteration is feasible for prolonged portosystemic shunts after living donor liver transplantation","volume":"44","year":"2014","journal-title":"Surg Today"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.24783","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01445473-201707000-00007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T01:00:47Z","timestamp":1705280447000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01445473-201707000-00007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6,20]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.24783","relation":{},"ISSN":["1527-6465","1527-6473"],"issn-type":[{"value":"1527-6465","type":"print"},{"value":"1527-6473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6,20]]}}}