Judiciously selected livers from aged donors are not associated with major increased susceptibility to ischaemia reperfusion injury.

As MIS approaches are increasingly used for ICC and GBC, monitoring surgical quality will be paramount. Laparoscopy, in particular, may fall short in achieving margin-negative resection and adequate regional lymphadenectomy.

Background: Piggy-back (PB) anastomosis with implantation on the common trunk is the standard technique for patients undergoing whole graft liver transplantation with caval preservation. While piggy back anastomosis with right hepatic vein (RHV-PB) implantation allows decreasing the risk of caval twisting in case of partial graft liver transplantation, its value in patients receiving small sized whole liver grafts and large hepatic fossa, remains poorly described. Methods: From 2010 to 2016, all patients undergoing whole graft liver transplantation with RHV-PB implantation were retrospectively analyzed. The choice of IVC anastomosis was decided during LT based on both graft size and recipient right upper quadrant depth. Operative time, cold and warm ischemia times, postoperative bleeding, and long-term patency were analyzed. Results: Among 596 patients receiving whole graft LT, 173 (29%) patients had RHV-PB. The rate of RHV-PB significantly increased from 8% in 2010 to 54% in 2016 (p < 0.001). Median age was 52.8 years (18e73) and 112 (64.7%) patients were male. Median graft weight and graft weight/recipients' weight were 1239 g (770e2000) and 1.7% (0.9e3.0), respectively. No IVC cross-clamping was required during the anhepatic phase. Skin only closure was required in 5 (2.9%) patients. Postoperative mortality occurred in 17 patients (9.8%) but no complication related to RHV-PB occurred during follow up (0e72 months). Conclusion: PB-RHV anastomosis is a safe and well tolerated technique, which may avoid the risk of caval twisting in patients receiving small whole liver grafts.