LAUSR

Domino liver transplantation (DLT) is an accepted strategy to increase the donor pool using the liver of a patient with an inborn metabolic disease with one from an elderly patient with a terminal liver disease. Recipients of domino grafts will develop metabolopathy years after the transplant. In the last decade, the double piggyback technique was proposed for DLT. The most important technical challenge is providing a sufficient length of the graft hepatic veins (HVs) to avoid an outflow problem (Budd-Chiari syndrome). During liver procurement, a section of the HV is at the level of the ostium in the hepatic parenchyma. If this is the case, then HV reconstruction is mandatory. Many different technical resources have been described, from a classic technique with cava resection and venousvenous bypass, to reconstruction with a cava patch, an iliac bifurcation graft, venoplasty with a venous patch or arterial patch, or performing a neocaval segment using both common iliac veins, among others. In 2004, our group performed the first DLT in Andalusia, Spain. Since then, 18 DLTs have been performed at our institution. Most of the outflow reconstructions were done using a common cava and iliac bifurcation graft. We present an alternative technique that is used when we do not have a suitable graft for this type of reconstruction or for the other previously described reconstructions. Our liver graft came from a multiorgan donation. The procurement was made by another liver team and was sent from another center with a single segment of the iliac vein as the available vascular graft.