Development of a suprahepatic recipient vena cava cuff for liver transplantation.

ONE of the most difficult parts of orthotopic transplantation of the liver is construction of the upper vena caval anastomosis at the diaphragm. The problems are caused by the recipient disease. With chronic hepatic disorders, there often is foreshortening and distortion of the suprahepatic inferior vena cava as well as retraction of the main hepatic veins into the scarred liver (Fig. lA and B). Consequently, when orthotopic transplantation of the liver is performed, development of a long enough suprahepatic vena cava cuff for anastomosis to its homograft counterpart has ranged from trying to almost impossible. We report here in a technical solution which has been used in the last 12 instances. The host liver is devascularized and mobilized by techniques described before, including cross clamping of the infrahepatic inferior vena cava ( 1, 2). The suprahepatic vena cava is encircled and cross clamped, but no attempt is made initially to mobilize the desired length for cuff development (Fig. 1 A). Instead, an anterior vertical incision is made in the cirrhotic liver (Fig. IA), and with knife dissection, this is carried directly posterior to the vena cava which is scraped clean (Fig. 1 B). Working from within the split