REPLACEMENT OF THE RETROHEPATIC VENA-CAVA IN SEGMENTAL LIVER-TRANSPLANTATION

Reduced grafts represent an important technical development in paediat ric liver transplantation. The use of a left lateral segment graft has required preservation of the native inferior vena cava to ''piggy-bac k'' the graft onto it, We report four children who underwent left late ral segment transplantation with caval replacement using the donor ili ac vein because the native retrohepatic inferior vena cava was small, friable or difficult to preserve. There were no caval or hepatic vein complications post-transplant and the donor iliac vein proved to be a satisfactory interpositional graft. The technique offers the advantage s of a wider retrohepatic cava avoiding venous outflow or caval obstru ction, provides good tissue to suture and is well suited for the trian gulation technique of the left hepatic vein.