• Daniel Azoulay, Cristiano Quintini, Michel Rayar, Chady Salloum, Laura Llado, Teresa Diago, Giuseppe D'Amico, Emilio Ramos, Joan Fabregat, Rony Eshkenazy, Edouard Bardou-Jacquet, Christophe Camus, Philippe Compagnon, Eric Vibert, and Chetana Lim.
• Hepato-Biliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.
• Ann. Surg. 2022 Dec 1; 276 (6): e825e833e825-e833.

ObjectiveTo evaluate the short- and long-term outcomes of RPA in a large multicentric series.Summary BackgroundThe current knowledge on RPA for portal reconstruction during LT in patients with diffuse PVT and a large splenorenal shunt is poor and limited to case reports and small case series.MethodsAll consecutive LTs with RPA performed in 5 centers between 1998 and 2020 were included. RPA was physiological provided it drained the splanchnic venous return through a large splenorenal shunt (≥ 1 cm diameter). Complications of PHT, long-term RPA patency, and patient and graft survival were assessed. RPA success was achieved provided the 3 following criteria were all fulfilled: patients were alive with patent RPA and without clinical PHT.ResultsRPA was attempted and feasible in 57 consecutive patients and was physiological in 51 patients (89.5%). Ninety-day mortality occurred in 5 (8.5%) patients, and PHT-related complications occurred in 42.9% of patients. With a median follow-up of 63 months, the 1-, 3- and 5-year patient and graft survival rates were 87%, 83%, and 76% and 82%, 80%, and 73%, respectively. The primary and primary-assisted patency rates at 5 years were 84.5% and 94.3%, respectively. Success was achieved in 90% (27/30) of patients with a follow-up ≥5 years.ConclusionsDespite a high rate of PHT-related complications, excellent long-term patient and graft survival could be achieved. RPA could be considered successful in the vast majority of patients. The expanded use of RPA is warranted.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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