Rofo 2019; 191(09): 847-848
DOI: 10.1055/a-0862-0778
The Interesting Case
© Georg Thieme Verlag KG Stuttgart · New York

4D Flow MRI for Monitoring Portal Flow in a Liver Transplant Recipient with a Renoportal Anastomosis

Alexander Lenz
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Lutz Fischer
2   Department of Hepatobiliary Surgery und Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Jun Li
2   Department of Hepatobiliary Surgery und Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Peter Bannas
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
16 May 2019 (online)

Introduction

Portal vein thrombosis (PVT), a common complication of end stage liver disease, is no longer considered a definite contraindication for liver transplantation (Paskonis M et al. Clin Transplant 2006; 20: 551–562). Creation of a renoportal anastomosis is a surgical strategy to secure portal flow to the liver graft in case of extensive PVT (Paskonis M et al. Clin Transplant 2006; 20: 551–562). We report a patient with PVT requiring liver transplantation with renoportal anastomosis. After transplantation, the patient developed severe bleeding from esophageal varices despite patency of the renoportal anastomosis. Secondary surgery, including esophagogastric devascularization for the prevention of further bleeding was discussed. 4D flow MRI, however, revealed orthograde flow not only in the renoportal shunt but also in esophageal varices, suggesting low risk for recurrent variceal bleeding, thereby averting secondary surgery.