title: An alternative surgical technique for caval preservation in liver transplantation.
abstract: BACKGROUND
  The results of orthotopic liver transplantation in patients with end-stage liver disease continue to improve. Refinements in surgical techniques represent an important part of this improvement.
  
  
  METHODS
  With the advent of split-liver and living-donor liver transplantation, inferior vena cava (IVC) preservation transitioned from being a potential option to being mandatory for many cases. Preserving the IVC can be a demanding technical maneuver in many liver transplants and several different approaches have been developed. When utilizing IVC preservation, there are several options for implantation of the graft. The piggyback technique, when feasible, is considered safe and provides hemodynamic stability for the recipient.
  
  
  CONCLUSIONS
  In some cases it may be difficult to perform the piggyback technique if intense inflammatory adhesions and severe significant collateral circulation exist between the IVC and the posterior segments of the liver. In these cases, the retro-hepatic dissection can be carried out with a different approach: the infrahepatic vena cava and the confluence of the three hepatic veins can be cross-clamped en-bloc without dissection.
  
  
  CONCLUSIONS
  This technique broadens the transplant surgeons' armamentarium and can be used in the setting of a very difficult retro-hepatic dissection. It is safe, and allows a shorter anhepatic phase with caval preservation.
authors.affiliation: Division of Transplantation, Department of Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA. cataldo.doria@jefferson.edu
authors.forename: Cataldo
authors.initials: C
authors.lastname: Doria
authors.forename: Adam S
authors.initials: AS
authors.lastname: Bodzin
authors.forename: Adam M
authors.initials: AM
authors.lastname: Frank
authors.forename: Warren R
authors.initials: WR
authors.lastname: Maley
authors.forename: Carlo B
authors.initials: CB
authors.lastname: Ramirez
mesh_terms: D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D014682:Vena Cava, Inferior / Q000601:surgery*
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