To determine whether large (diameter is greater than or equal to 1 cm) portal shunt should be ligated in liver transplantation recipients with adequate intraoperative portal flow.

The clinical data of 76 recipients (all the donors were from organ donation after citizen′s death) who received orthotopic liver transplantation were retrospectively analyzed in the Organ Transplantation Department of Tianjin First Central Hospital from January 1, 2015, to October 30, 2018. The diameter of portal shunt vessels in all recipients was ≥1 cm, and the portal vein blood flow after reperfusion in liver transplantation was 100-250 mL·100 g^-1·min^-1. The recipients were divided into ligation group (43 cases) and non-ligation group (33 cases) according to whether shunt vessels were ligated during operation. The perioperative data, postoperative survival, postoperative transplant liver dysfunction and complications in the ligated group and the unligated group were observed. The group or paired t test was used to compare the data with normal distribution, the rank sum test was used to compare the data with non-normal distribution, and the Chi-square test or Fisher′s exact probability method was used to compare the enumeral data. Kaplan-Meier method was used to draw the survival curve, and log-rank test was used to compare the survival rates. P<0.05 was considered statistically significant.

In the ligation group, the main portal vein blood flow increased from (120±25) mL·100 g^-1·min^-1 to (182±66) mL·100 g^-1·min^-1 after reperfusion, and the difference was statistically significant (t=5.761, P<0.05). The main portal vein blood flow after reperfusion was (127±24) mL·100 g^-1·min^-1 in the non-ligation group and (182±66) mL·100 g^-1·min^-1 in the ligation group, and the difference was statistically significant (t=4.556, P<0.05). The incidence of postoperative Clavien Ⅲ-Ⅳ complications in the ligation group (8 cases, 18.6%) was lower than that in the non-ligation group (14 cases, 42.4%), which had statistical significance (χ²=5.15, P<0.05). All the recipients were followed up until October 2020, no primary graft infunction, death or portal vein related complications were found in the 2 groups, and the portal vein had sufficient flow. The incidence of transplant liver dysfunction in the ligation group (7.0%, 3/43) was lower than that in the non-ligation group (30.3%, 10/33), the difference was statistically significant (χ²=7.165, P<0.05). The 1, 2 and 3 year survival rates in the ligation group were 88.4%, 86.2% and 85.2%, respectively, and those in the non-ligation group were 85.5%, 83.1% and 81.9%, respectively, with no significant difference between the 2 groups (χ²=0.385, 0.344 and 0.327, all P>0.05).

For orthotopic liver transplantation recipients with sufficient intraoperative flow of the main portal vein (100-250 mL·100 g^-1·min^-1), ligation of portal vein shunt vessels with diameter ≥1 cm is still recommended.