Non-tumoral portal vein thrombosis is present at the time of liver transplantation in 5–26% of cirrhotic patients. The prevalence of complex portal vein thrombosis has been reported in 2.2%. Portal inflow reconstruction is defined as non-physiological when porto-portal anastomosis could not be performed. In addition to porto-portal anastomosis, the reconstruction of portal flow is physiological when the splanchnic venous blood from a large portosystemic shunt (spontaneous or surgical) can be directed to the graft, either by anastomosis of the shunt to the graft portal vein or anastomosis of the tributary of the inferior vena cava (which drains this shunt) to the graft portal vein.