Cavoportal hemitransposition in liver transplantation: towards a more safe and efficient technique.

Extended splanchnic venous thrombosis represents a challenge for the liver transplant surgeon. In the absence of large venous tributaries, the cavo-portal hemitransposition (CPHTr) and the combined liver-intestinal or multi-visceral transplantation are the only technical solutions. Due to the reported high morbidity and mortality rates (it is used infrequently and lacks standardization), the former technique has (almost) been abandoned by the transplant community. A newly designed technique of CPHTr based on the combination of inferior vena cava sparing hepatectomy, large latero-lateral cavo-caval and end-to-side cavo-portal anastomoses, separated only by a double vascular stapler line is presented. This technique allows the splanchnic blood completely to be diverted towards the allograft and to eliminate low flow IVC areas, possibly leading to complications. Conclusion: The here proposed modified CPHTr technique offers a valuable alternative to much more complex and invasive intestinal transplantation procedures