PMC2935162_01
Anhepatic phase: the IVC is tangentially clamped but the portal flow is guaranteed by the TPMHV which lies just above the caval clamp (IVC: inferior vena cava, MHV: middle hepatic vein shunt, RHV: right hepatic vein, and PV: portal vein).
JTRAN2010-570392.001.jpg
PMC2935162_01_JTRAN2010-570392.001.jpg
fig1
A temporary end-to-end porto-middle hepatic vein anastomosis was created using a running suture (Prolene 5/0; Ethicon, Somerville, NJ), instead of the standard TPCS (Figure 1).
Creation of the end-to-side caval anastomosis is not impeded by the presence of the TPMHV (CL: caudate lobe, rIVC: recipient's inferior vena cava, gIVC: graft's inferior vena cava, MHV: middle hepatic vein, PV: portal vein, and TPMHV: temporary porto-middle hepatic vein shunt).
JTRAN2010-570392.002.jpg
PMC2935162_01_JTRAN2010-570392.002.jpg
fig2
After a longitudinal incision of the recipient IVC anterior wall, the graft was placed orthotopically and rotated to the right, and an end-to-side anastomosis between donor and recipient IVC was performed (Figure 2).