Optimizing Outflow in Piggyback Liver Transplantation Without Caval Occlusion: The Three-Vein Technique,'' which was recently published in Liver Transplantation. The purpose of this report is to present a safe, reliable, and reproducible piggyback technique without occlusion of the inferior vena cava. The 3-vein technique described in this article appears to be the most physiological way of achieving this goal. 2 Furthermore, Tayar et al. state that this approach to creating a large 3-vein stoma without complete occlusion of the vena cava has not previously been described clearly in the literature. Although the technical description and the photographs in their article are of excellent quality, more discussion is mandatory. First, in the March issue of the Journal of Gastroenterology and Hepatology, our group from Strasbourg reported a large series of 423 consecutive adult piggyback liver transplants with the 3 suprahepatic veins. 3 The technique and the intraoperative view reported in this article are quite similar. Furthermore, our anastomosis also allows optimal venous drainage of the graft and can be created with partial clamping of the native inferior vena cava. Therefore, our article must be cited in the reference section. Second, according to our extensive experience with the 3-vein technique, the origin of the right suprahepatic vein is far from the common suprahepatic trunk in some cases; therefore, achieving a large 3-vein stoma without partial occlusion of the inferior