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/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.