“Piggyback” orthotopic liver transplantation is a technical modification of the standard technique that has found favor with a number of surgeons. One possible complication is that of venous outflow obstruction, which presents as an acute Budd-Chiari syndrome. If not rapidly corrected, it is almost inevitable that the newly implanted graft will fail. Additionally, severe portal hypertension and general infradiaphragmatic venous stasis may compound the damage. We find that anastomosing the donor infrahepatic vena cava to the recipient suprarenal vena cava in an end-to-side fashion is an excellent way to correct the problem.