*Purpose: Few published reports have suggested lower blood loss in association with early portal vein ligation (e-PVL) during liver transplantation surgery, however there are currently no studies describing the outcomes with respect to hepatectomy duration or the relationship of e-PVL to recipient hepatectomy time (ePVL/H ratio). The aim of this study is to evaluate possible effects of shortened hepatectomy in conjunction with e-PVL on surgical and post-transplant outcomes.

*Methods: We evaluated adult deceased donor liver transplants between 2013-2018. Patients undergoing re-transplant, multiorgan or living donor liver transplantation were excluded. Possible effects of hepatectomy and additionally e-PVL on surgical and post-transplant outcomes were assessed. Patients were categorized into 2 groups: shorter (<90 minutes) and longer hepatectomy groups (≥90 minutes).

*Results: A total of 451 patients were eligible. Median PVL and hepatectomy time were 90 and 129 minutes, respectively. Of these 451 patients, 57 and 384 were categorized into the shorter and longer hepatectomy groups. Recipient characteristics, including MELD score, were similar between two groups. Shorter-hepatectomy group had significantly shorter PVL time (47 vs 97 minutes, P<0.001) and lower e-PVL/H ratio (0.60 vs 0.72, P<0.001). The shorter hepatectomy group had lower amount of RBC (2 vs 4 units, P=0.014) and FFP (4 vs 6 units, P=0.007) transfusion and shorter cold ischemia time (4.8 vs 5.1 hours, P=0.049). One-year patient survival was comparable (97.9% vs. 91.8%, P=0.100). Longer hepatectomy time, but not PVL, was associated with an increased risk of one-year post-transplant mortality (HR 1.01 [per minute], p=0.021).

*Conclusions: In the setting of shortened recipient hepatectomy, early portal vein ligation with respect to hepatectomy duration may contribute to improved surgical outcomes.

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