The prevalence of spontaneous portosystemic shunts is reported to be around 20–40% in end-stage liver disease patients undergoing liver transplantation. These large spontaneous portosystemic shunts, when left in place at liver transplantation, have been associated with an increased risk of primary nonfunction and primary dysfunction, portal vein thrombosis, or encephalopathy possibly due to the so-called portal flow steal phenomenon and the subsequent decreased portal inflow to the graft. To prevent these complications, some have advocated ligation or division of these large spontaneous portosystemic shunts following graft revascularization.