Adult-to-adult living donor liver transplantation in severe portosystemic shunt cases.

To date, the need for spontaneous portosystemic shunt division during adult-to-adult living donor liver transplantation (LDLT) remains unknown. This study reports 2 patients with large portosystemic shunts who required LDLT. The first patient was a 40-year-old male with liver cirrhosis due to hepatitis C. The angiogram showed splenosystemic shunts with hepatopetal flow. Shunt occlusion was not performed after implanting a small-size graft because sufficient portal blood flow was observed. On the first postoperative day, portal blood flow was not detected; therefore shunt occlusion was per formed and the portal blood flow was restored. The second patient was a 51-year-old female with primary biliary cirrhosis. Marked collateral circulation with hepatofugal flow was observed. Shunt occlusion was performed after implanting a medium-size graft. Postsurgery, hepatopetal portal blood flow was observed and the postoperative course was satisfactory. These cases demonstrate that large portosystemic shunts should be ligated to maintain adequate portal blood flow that corresponds to the graft volume.