Vascular and Biliary Anastomoses in Deceased Donor Orthotopic Liver Transplantation

There are a total of five structures that have to be reconstructed in DDLT. These include the suprahepatic and infrahepatic vena cava, the portal vein, the hepatic artery and the bile duct. Prior to describing the various methods of implantation of the donor liver, we will briefly review the different options available for the recipient hepatectomy, as the surgeon’s choice of reconstruction of the vena cava will dictate the type of hepatectomy performed. For a bicaval anastomosis, the hepatectomy involves completely dissecting out the supraand infrahepatic vena cava, mobilizing the inferior vena cava (IVC) off of the retroperitoneum, achieving full vascular isolation and subsequently removing the intrahepatic portion of the IVC with the native liver. In this scenario, the use of venovenous bypass may be required for hemodynamic stability of the patient. The traditional method involves reconstruction of the suprahepatic and infrahepatic donor cava to the corresponding structures in the recipient.