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Fig. 9.4A and B. A) Piggyback technique. This figure illustrates the preparation for the piggyback cavo-cavo plasty. First, the donor suprahepatic IVC is viewed from the back where a vertical slit is made in the middle of the back wall. This is triangulated to match the triangulated hepatic vein opening on the recipient side. Finally, the liver is viewed after all of the anastomoses have been completed showing an end on view. B) Side view of the piggyback procedure. Showing the triangulated cavo-cavo plasty of the donor suprahepatic IVC and the ligated infrahepatic IVC.

the cut surface needs to be secured and a careful check for biliary leaks in the raw surface needs to be carried out. Split liver transplant, when performed on proper recipients using suitable donor organs has survival results comparable to whole livers, but is associated with a higher rate of surgical complications.20,21

"Auxiliary Procedure"

In selected recipients with either metabolic diseases or acute liver failure, auxiliary transplants have been performed. A left lobe resection of the native liver is carried out and a donor left lateral segment or left lobe is transplanted orthotopically by anastomosing the donor left hepatic vein to recipient IVC end-to-side and portal vein hepatic artery and bile duct connections constructed in standard fashion. Nuclear studies are used to follow uptake/function by the donor/recipient liver, and in cases where the native liver recovers, the donor liver is either allowed to atrophy following withdrawal of immunosuppression, or is removed. Alternatively, the donor liver is treated like any other transplanted liver and ultimately becomes the predominantly functioning liver. Differential portal venous flow between recipient and donor liver segments may be responsible for preferential function and hypertrophy.

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