Spontaneous portosystemic shunts (SPSS) are commonly observed in patients undergoing living donor liver transplantation (LDLT); however, their impact on the outcome after transplantation is unclear. We aimed to assess the type, size, and the effects of SPSS on outcomes after LDLT. A total of 339 LDLT recipients in a single institution were included. The type and diameter of the SPSS (splenorenal shunt [SRS], oesogastric shunt, and umbilical shunt) were retrospectively analyzed. A large shunt was defined as having a diameter ≤7 mm. No portal flow modulation was attempted over time. Portal complications were defined as stenosis, thrombosis, or hepatofugal flow requiring any treatment after transplantation. There were 202 (59.0%) patients who exhibited at least 1 large SPSS. Neither the size nor type of SPSS was associated with mortality, morbidity, or liver function recovery. However, the incidence of portal complications was significantly higher in patients with a large SRS (8.6% versus 2.9%; P = 0.04). Multivariate analysis of portal complications revealed 2 independent predictors: pre‐LT portal vein thrombosis (PVT) and SRS size. The observed risk among recipients with pre‐LT PVT was 8.3% when the SRS was ≤7 mm, but increased to 38.5% when the SRS was >15 mm. The present study suggests that large SPSS do not negatively affect the outcomes after LDLT. However, a large SRS is associated with a higher risk of portal complications, particularly in recipients with pre‐LT PVT, for whom intraoperative intervention for SRS should be considered. Otherwise, a conservative approach to SPSS during LDLT seems reasonable.

中文翻译：

---

自发性门体分流术在活体肝移植中的临床意义。

自发性门体分流术 (SPSS) 在接受活体肝移植 (LDLT) 的患者中很常见；然而，它们对移植后结果的影响尚不清楚。我们的目的是评估 SPSS 的类型、大小和对 LDLT 后结果的影响。一个机构共有 339 名 LDLT 接受者被纳入。回顾性分析了 SPSS（脾肾分流术 [SRS]、胃肠分流术和脐带分流术）的类型和直径。大分流定义为直径≤7 mm。随着时间的推移，没有尝试进行门户流量调制。门静脉并发症定义为移植后需要任何治疗的狭窄、血栓形成或离肝血流。有 202 名 (59.0%) 患者表现出至少 1 个大型 SPSS。SPSS 的大小和类型都与死亡率、发病率、或肝功能恢复。然而，大 SRS 患者的门脉并发症发生率明显更高（8.6% 对 2.9%；P  = 0.04）。门静脉并发症的多变量分析揭示了 2 个独立的预测因素：LT 前门静脉血栓形成 (PVT) 和 SRS 大小。当 SRS ≤ 7 毫米时，在 LT 前 PVT 接受者中观察到的风险为 8.3%，但当 SRS >15 毫米时增加到 38.5%。本研究表明，大型 SPSS 不会对 LDLT 后的结果产生负面影响。然而，较大的 SRS 与较高的门脉并发症风险相关，尤其是在 LT 前 PVT 的接受者中，应考虑对这些患者进行术中 SRS 干预。否则，在 LDLT 期间对 SPSS 采取保守的方法似乎是合理的。