*Purpose: Side-to-side cavocavostomy (STSCC) is an alternative caval sparing implantation technique for liver transplantation (LT), but despite its technical ease compared to traditional piggyback (TP) technique, STSCC is not commonly used and the associated perioperative and short-term outcomes remain unclear.

*Methods: In July 2017, STSCC was adopted as the standard implantation technique at our institution. Prior to this, our group exclusively performed TP for all deceased donor grafts. Our program consists of four transplant surgeons who perform an average of 105 liver transplants annually with use of caval sparing hepatectomy technique without venovenous bypass in all cases. We analyzed 145 consecutive STSCC patients after July 2017 compared with 145 prior consecutive TP patients. Patient factors, donor characteristics, and perioperative outcomes were compared. Primary endpoints were operation length and perioperative transfusion requirements.

*Results: There were no significant differences in donor characteristics, recipient age, gender, race, etiology of liver disease, or medical history between groups. Total and warm graft ischemia time were similar between the groups, but total operative time was significantly decreased in the STSCC group (271 vs 309 min, p<0.001). STSCC was associated with lower intraoperative red blood cell (RBC, 2 vs 5 units), fresh frozen plasma (5 vs 10 units), cryoprecipitate (cryo, 0 vs 1 unit), platelet (1 vs 2 units) transfusions, as well as decreased cell saver use (1 vs 2 L) (each p<0.001). There were also lower rates of temporary abdominal closure compared to TP (8.3% vs 24.1%, p<0.001) and lower rates of ventilation >24 hours (17.2% vs 27.6%, p=0.048). STSCC patients had lower postoperative transfusion rates of RBC (35.9% vs 21.4%, p=0.009) and cryo (18.6% vs 9.7%, p=0.04), but there were no other differences in perioperative and short-term outcomes.

*Conclusions: In our experience, in addition to technical ease, STSCC was associated with shorter operative time and lower transfusion requirements. To determine the optimal implantation technique in deceased donor liver transplantation, future studies should evaluate these techniques in a prospective multi-center randomized approach.

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