Background: Vascular complications still remain a significant cause of morbidity, graft loss and mortality following liver transplantation (OLTx). These include predominantly hepatic artery and portal vein thrombosis or stenosis. Venous outflow obstruction may be specifically related to the technique of Piggy-Back OLTx.
Material/Methods: Between February 2002 and February 2009, we performed 200 Piggy-Back OLTx in 194 recipients. The temporary portacaval shunt was created in 43 (22%) cases while the graft implantation was routinely performed with end-to-side cavo-cavostomy in all patients. The preexistent partial portal and superior mesenteric vein thrombosis was present in 17 patients in whom eversion thrombectomy was successfully performed. This was followed by typical end-to-end portal anastomosis. The donor's hepatic artery was anastomosed with the recipient aorta via an iliac interposition graft in 29 (15%) patients.
Results: A total of 15 (8%) vascular complications were found including  hepatic artery thrombosis (n=6), hepatic artery stenosis (n=3), aortic/celiac trunk rupture (n=2), portal vein stenosis (n=2) and left and middle hepatic venous outflow obstruction (n=1). There was also one case of arterial steal syndrome via the splenic artery. There was no portal/mesenteric vein thrombosis in any patient. Therapeutic modalities included re-LTx, arterial/aortic reconstruction and splenic artery ligation. Vascular complications resulted in mortality in 5 (33%) patients.
Conclusions: Our experience indicates that Piggy-Back liver transplantation with end-to-side cavo-cavostomy has a very low risk of venous outflow obstruction. Partial portal/mesenteric vein thrombosis is no longer an obstacle to LTx and can be successfully managed by the eversion thrombectomy technique.

Keywords: Liver Transplantation, clinical outcome