Management of Spontaneous Portosystemic Shunts in 231 Patients Who Underwent Living Donor Liver Transplantation: A Retrospective Study from a Single Center in Nagasaki, Japan.

BACKGROUND We have ligated spontaneous portosystemic shunts (SPSS) in living donor liver transplantation (LDLT) when a postoperative interventional radiology (IVR) approach was impossible or the intraoperative hepatopetal flow was insufficient. This retrospective study from a single center in Nagasaki, Japan aimed to investigate the management of SPSS in 231 patients who underwent LDLT between January 2006 and December 2019. MATERIAL AND METHODS SPSS were identified in 63 patients (27.3%). Perioperative factors and survival rates were compared in the study population with SPSS divided into 2 groups: the ligation group and the non-ligation group. The post-transplant course was examined in greater detail in the non-ligation group. RESULTS SPSS were ligated in 20 patients (31.7%). The indication for shunt ligation was an impossible postoperative approach (10 patients; 50%) or poor intraoperative hepatopetal flow (10 patients; 50%). There was no significant difference in the 1- and 5-year overall survival rates between the ligation and non-ligation group (80%, 80% vs 76%, 55%, respectively, P=0.17). Of the 34 patients in the non-ligation group who could be observed for 6 months, 14 patients (48.3%) had a spontaneous regression of SSPS. Additionally, 5 patients who required postoperative IVR had a good clinical course. There was no graft failure or adverse events in the non-ligation group. CONCLUSIONS Unnecessary ligation could be avoided by using our criteria. When postoperative IVR is possible with sufficient intraoperative hepatopetal flow, SPSS do not always need to be ligated in LDLT.