The evolution of liver transplantation techniques has shifted from the classical (conventional) approach, which involves removal of the retrohepatic inferior vena cava (IVC) and typically requires veno-venous bypass, to the piggyback technique, which preserves the recipient’s IVC and offers improved hemodynamic stability. While the classical method remains useful in complex cases (e.g., IVC thrombosis, Budd–Chiari syndrome), the piggyback approach has become the preferred standard due to reduced operative time, lower blood loss, avoidance of VVbypass, and equivalent long-term graft and patient survival. Advances such as modified piggyback techniques and improved intraoperative imaging have further optimized outcomes. Today, piggyback liver transplantation is used in the majority of adult and pediatric cases worldwide, representing a significant advancement in surgical safety and efficiency.