Orthotopic liver transplantation

The original technique of orthotopic liver transplantation (LT) envisages the removal of the native liver together with the infrahepatic inferior vena cava (IVC), while a subsequent evolution of this procedure includes the preservation of the IVC. In this latter case, the outflow reconstruction is achieved with an anastomosis of the donor IVC to the stump of the three major hepatic veins or to the IVC of the recipient. The two techniques had undergone a few modifications since their initial proposal. Although it is generally recognized that the preservation of the IVC carries some advantages in terms of shorter operation time, avoidance of venovenous bypass, and better hemodynamic stability and renal function, at present there is no definite agreement on which technique actually leads to better results. The sequence of vascular anastomosis is the same with the two techniques, that is, caval, portal, and arterial anastomoses, in an end-to-end fashion and with the general concept of avoiding an excessive length. Biliary reconstruction is the last step of the operation, and it is performed between the donor and recipient bile ducts or with a bilioenteric anastomosis.