Figure 56-4 A, With the use of a caval interpositional technique immediately before the anhepatic phase, the suprahepatic and infrahepatic vena cava and the portal vein are clamped. The hepatic artery is frequently clamped late in the dissection phase. B, Anastomoses during liver transplantation. The donor's suprahepatic and infrahepatic venae cavae are anastomosed to the recipient, followed by the portal vein. Frequently, the hepatic artery and bile duct are anastomosed in the reperfusion phase. A Roux-en-Y loop of the small intestine is an alternative biliary drainage conduit. Reconstruction of the hepatic artery, portal vein, or bile duct is occasionally necessary. Placement of a T-tube for drainage of the bile duct is not mandatory and is increasingly not being performed. (From Hardy JD: Hardy's Textbook of Surgery, 2nd ed. Philadelphia, JB Lippincott, 1988.)