Abstract
A patient with friable hepatic artery and poor hepatic arterial inflow, portal vein thrombosis and serious gastroesophageal varices underwent modified piggyback liver transplantation. The hepatic artery was reconstructed by interposing donor's iliac arterial conduit anastomosed to the infrarenal aorta, while the portal vein flow was ensured by the interposition of donor's iliac venous graft. The graft function and blood flow through the anastomosis remains excellent more than 8 years postoperatively. We consider the interposition of iliac vessels is a viable alternative for arterial and portal reconstruction in adult liver transplantation when direct arterial or portal anastomosis cannot be routinely performed.