AbstractBackgroundDiffuse splanchnic thrombosis may render standard LTx difficult or even technically impossible. A 19‐year‐old woman with acute‐on‐chronic Budd‐Chiari syndrome and complete splanchnic thrombosis underwent conventional LTx. Only limited anatomical portal inflow could be restored, and urgent re‐transplantation for recurrent splanchnic vein thrombosis became necessary.MethodsAt re‐transplant, and in addition to the reestablishment of some portal inflow through the preserved original porto (native)‐portal (graft) connection, a cavoportal shunt was created (first partial via 30% tapering of the vena cava, but eventually complete by total occlusion of the vena cava).ResultsThe postoperative course was then uneventful, and interestingly, the native portomesenteric axis gradually reopened. Two years post‐transplant, the liver graft is perfused via both physiological and non‐physiological sources. Liver function is normal. There is no IVC syndrome and no residual PHT. She is leading a normal life.ConclusionCreation of CPHT, in addition to the preservation of portal inflow from the native splanchnic system, should be considered in patients with diffuse splanchnic thrombosis, when sufficient physiological portal inflow cannot be restored at the time of LTx, but in whom the splanchnic circulation may reopen up later.