Introduction: The Cavaplasty OLT, now called Hug Procedure, offers advantages for hepatectomy and implantation and eliminates outflow obstruction. However, caval clamping is required during the anhepatic phase, which is challenging in patients with intolerance to cava clamping, preexisting cardiac disease or hemodynamic instability. The Modified Hug Procedure was designed to overcome these shortcomings by avoiding caval cross clamping. These techniques were compared for feasibility, anhepatic phase time, operative time, intraoperative blood requirements, surgical complications, hospital length of stay (LOS), and patient/graft survival.

Methods: 108 first time adult OLTs between May 2005 and December 2010 were reviewed. Patients were grouped in two eras: Era 1 (Hug Procedure), was from May 2005 to June 2009 (n = 73); and Era 2 (Modified Hug Procedure) was from July 2009 to December 2010 (n = 35). The median MELD at transplant was 21 (12-45) in Era 1 and 22 (13-34) in Era 2. Donors were procured using the standard technique. Immunosuppression consisted of tacrolimus, myfortic and prednisone. All patients were followed for at least 2 years with median follow up of 4.6 years.

Results: Cumulative patient survival at 1 year was 98.8% for Era 1 and 97.1% for Era 2. Cumulative graft survival at 1 year was 95.9% for Era 1 and 91.4% for Era 2. Table 1 displays a comparison of outcomes for Era 1 and Era 2. There were no differences in operative time, pRBC units, or hospital LOS. Anhepatic phase was significantly shorter (p < 0.01) for Era 2 than Era 1. No patients were placed on bypass. There were 4 bile leaks (all resolved by ERCP), 1 intrahepatic artery thrombosis and 1 post operative bleed in Era 1. There was no outflow obstruction in either group.

Conclusion: The Modified Hug Procedure is as feasible, safe and effective as the original Hug Procedure. The caval flow preservation avoids bypass and pressors administration, making this new technique particularly suitable in cases of hemodynamic instability, intolerance to vena cava cross clamping and preexisting cardiovascular disease.

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