P596 Aims: Earlier reports from our centre showed the successful use of autologous rectus fascia sheath (ARFS) in vascular defects in animal experiments. This report concerns its first use in a patient. A 28 years old female (58 Kg) with Budd Chiari syndrome was referred for liver transplantation. An ABO identical donor liver (50 Kg) with good donor parameters became available. During inspection of the graft it was noted that the donor inferior caval vein (ICV) segment was short. Explantation of a huge (4.7 kg) native liver from the recipient was technically demanding. Preservation of the recipient ICV was not possible due to the large dimensions of the caudate lobe of the recipient liver and its adherence to the compressed and small ICV. The explantation resulted in a larger than expected defect in the recipient ICV. Methods: To solve this problem in the absence of allogeneic material for ICV reconstruction an ARFS was harvested from the posterior rectus sheath of the recipient’s abdominal wall. A tubular interponate was constructed with the mesothelium at the inner side (3.5 cm long). It was connected to the infra hepatic ICV of the donor. Orthotopic implantation was performed according to standard techniques. Results: The liver graft showed immediate function and the patient was extubated after 24 hours. Immunosupression consisted of Tacrolimus and low dose prednisolon and the patient was put on anticoagulation (Fragmin®). Liver and kidney function normalized during the post operative course which was uneventful. Repeated Doppler ultra sound investigations showed good flow (flow rate 35 cm/sec) in the ICV and interponate in cranial direction. The diameter of the interponate (10 mm) was narrower compared to the native ICV (15 mm). No signs of thrombosis were observed. After three weeks the patient was discharged. After three month’s post operatively the patient is at home and well. Cavography at three months after the procedure showed a slight narrowing of the ARFS with still adequate flow. However to prevent further narrowing an expandable metal stent was placed. Conclusions: ARFS can be used successfully as replacement of ICV defects in liver transplantation.