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Caval preservation with reconstruction of the hepatic veins using caval‐common iliac bifurcation graft for domino liver transplantation

Domino liver transplantation has been performed routinely from livers procured from patients with Familial Amyloidosis (FA). Some technical modifications have been made on the recipient of Amyloid Hepatic Allograft (AHA) to overcome the cuff limitation such as the use of side to side cava-caval anastomosis with closure of the suprahepatic and infrahepatic cava. These technical innovations in the recipient AHA however have no benefit for the FA patient undergoing the hepatectomy and may in fact adversely affect the safety of the harvesting procedure by requiring high dissection of the IVC into the diaphragm. In addition the IVC is removed with the liver, therefore requiring complete supra-renal vena caval clamping and the use of veno-venous bypass. We describe a safe and simple technique to recover the AHA without the IVC.