The role of spontaneous portal-systemic shunts in liver transplantation: Case report and literature review

Tielong Wang, Jinlong Gong, Zhitao Chen, Changjun Huang, Jia Yu, Zhiyong Guo, Xiaoshun He

Research output: Contribution to journalArticlepeer-review


We described two liver transplants for patients with end-stage liver disease and spontaneous portal-systemic shunt (SPSS). We ligated the splenorenal shunt (SRS) in the first case but did not ligate it in the second case. Postoperative examination revealed significant differences in portal blood flow velocity, serum ammonia level, liver function and prognosis between two cases. The portal blood flow in the first case was sufficient with decreased serum ammonia and immediate liver graft function. The portal blood flow was insufficient and serum ammonia level was not significantly reduced after operation in the second case probably because SRS was still present after surgery. The first case recovered well after operation and was discharged uneventfully, however, the second patient suffered early allograft dysfunction (EAD) after operation and died of pulmonary infection on postoperative day (POD) 18. Proper management of SPSS in liver transplantation (LT) is important because it can affect the function of liver graft and patient prognosis, so we reviewed the relevant literature and list different types of SPSS and their clinical characteristics. We recommend that SPSS greater than 8 mm in diameter should be ligated in LT with non-small size graft to ensure adequate portal flow and preserved with small size liver graft to avoid portal hypertransfusion and portal hypertension except obviously insufficient portal blood flow.

Original languageEnglish (US)
Pages (from-to)8365-8370
Number of pages6
JournalAnnals of Palliative Medicine
Issue number7
StatePublished - Jul 2021


  • Hepatic encephalopathy (HE)
  • Liver transplantation (LT)
  • Small-for-size syndrome (SFSS)
  • Splenorenal shunt (SRS)
  • Spontaneous portal-systemic shunt (SPSS)

ASJC Scopus subject areas

  • Advanced and Specialized Nursing
  • Anesthesiology and Pain Medicine


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