The illustration shows the preparation of the vessels and the attachment of the organ in a piggyback liver transplant. A piggyback liver transplant is different from a stand liver transplant in that the recipient vena cava remains intact. The donor vena cava is ligated inferiorly and the superior end of the vessel is prepared for anastomosis by trimming the posterior aspect of the vena cava to a point inferiorly (top left). A triangular hole is made in the recipient vena cava (top inset). Finally, the donor vena cava is anastomosed to the intact recipient vena cava. Through this attachment, the donor and recipient vena cavas are "piggybacked" onto each other. This triangular anastomosis protects against the weight of the liver piggybacked to the recipient vena cava kinking off the venous return of the transplanted organ which would lead to secondary necrosis of the organ.

Pen and ink illustration.

For Michael Abecassis, MD; Department of Surgery, Northwestern University; Chicago, Illinois.

Published as:
Abecassis MM, Blei AT, Flamm S, Fryer JP. Liver Transplantation. In: Stuart FP, Abecassis MM, Kaufman DB, eds. Organ Transplantation. Georgetown: Landes Bioscience, 2000: 188. Publications

Shown at: Association of Medical Illustrators Salon. Atlanta, Georgia. July 29-August 1, 1999. Exhibits

© 1999, Bill Walsh.