Domino Liver Transplantation With Double Piggyback: Is This the Best Technique? A Case Report

Garcia, José Huygens Parente; Vasconcelos, J.B.M.; Costa, Paulo; Coelho, Gustavo; Brasil, Ivelise Regina Canito; Barros, Marcos Aurélio Pessoa; Borges, G.C.; Mesquita, D.F.G.; Takata, Iori; Rangel, M.L.M.

doi:10.1016/j.transproceed.2006.08.101

Cited by 8 publications

(3 citation statements)

References 6 publications

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“…It is of note that eight patients presented a venous outflow obstruction and that six patients needed to be re-transplanted [16]. The fact that 16 more technical modifications have been reported during the period 2001-2019 indicates the need for further standardization and simplification of the technique [8,28,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. The venous outflow reconstruction of the domino-graft, such as described here, is in line with this.…”

Section: Discussionsupporting

confidence: 67%

Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient

et al. 2020

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Domino-liver transplantation represents a rare chance to expand the donor liver pool. Fear of putting both donor and recipient at disadvantage has meant that the procedure has not been applied universally. A modification of the original technique which allows both safe procurement of the graft as well as safe implantation of the reconstructed graft in the domino-graft recipient using a 180° rotated, adequately trimmed, free iliaco-caval venous graft is described in detail.

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Section: Discussionsupporting

confidence: 67%

Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient

et al. 2020

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“…Theoretically, maintenance of the hemodynamic stability also avoids venovenous bypass from attending complications. In fact, some centers prefer preservation of the IVC in FAP patients during native liver hepatectomy for hemodynamic stability while obviating venovenous bypass 8. We have nevertheless developed implantation of the liver graft in LDLT with cross‐clamp of the IVC while still obviating venovenous bypass 9.…”

Section: Discussionmentioning

confidence: 99%

Simplifying hepatic venous outflow reconstruction in sequential living donor liver transplantation

Chan

et al. 2009

Liver Transpl

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The native liver of a familial amyloidotic polyneuropathy recipient who undergoes living donor liver transplantation used as a graft for sequential liver transplantation does not include the inferior vena cava. Implantation of this whole liver graft to a second recipient could be simplified by borrowing the experience from right liver living donor liver transplantation. With careful release of the hepatic vein from its surrounding adventitia mainly by sharp dissections, adequate lengths of these veins could be attained without compromising the native inferior vena cava. Following venoplasty of the right and middle/left hepatic vein stumps, the single cuff of the hepatic veins is anastomosed to the inferior vena cava without interpositional venous graft or patch. Satisfactory venous outflow is reliably achieved because this is the most direct outflow tract. Liver Transpl 15: 1514Transpl 15: -1518Transpl 15: , 2009 Sequential liver transplantation using a deceased donor liver graft for familial amyloidotic polyneuropathy (FAP) is well described.1 Classically, the liver explanted from a patient with FAP, or an amyloid hepatic allograft (AHA), is transplanted to a second recipient (AHA recipient). The latter is usually greater than 60 years old, because the AHA will continue to produce variant transthyretin, resulting in neuropathy years later. In deceased donor sequential liver transplantation, the inferior vena cava (IVC) is included in the deceased donor liver graft and also in the AHA. Therefore, graft implantation is by end-to-end IVC anastomosis for both recipients. Total hepatectomy of the patient with FAP is similar to standard deceased donor liver transplantation, except that the suprahepatic and infrahepatic IVC of a just adequate length are included in the AHA for implantation in the AHA recipient. It is important to note that the FAP patient should not be considered at a disadvantage for being a living liver donor in the recipient total hepatectomy. A way to maintain the IVC flow during the anhepatic phase and without venovenous bypass is application of the piggyback technique.2 This has been applied to patients with FAP who had side-toside cava-caval anastomosis and closure of the suprahepatic and infrahepatic cava. 3In the case of living donor sequential liver transplantation, however, the IVC of the FAP patient has to be preserved in all cases and is not included in the AHA explanted from the FAP patient. This AHA, which is a whole graft and devoid of the IVC for implantation to the AHA recipient, also requires unimpeded venous outflow. The procedure, though akin to the piggyback technique, is different because the length of the hepatic veins in the AHA graft is limited. FIRST RECIPIENTThe patient with FAP was 42 years old. Her main symptoms were peripheral, and autonomic polyneuropathy manifested as numbness of the limbs and constipation. She also had weight loss of 7 kg over a 1-year period. Antral biopsy by upper endoscopy revealed Congo redstained amyloid deposits in the muscularis mucosae. E...

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“…65,86 89,90 Atualmente, aperfeiçoamentos técnicos permitem a realização do Tx em dominó, mesmo com a preservação da VCI no receptor com PAF. 91,92,93 No 13,58 Habitualmente, gradientes de até 3 mm Hg são considerados discretos. 21,82 Ducerf e cols.…”

Section: A Concepção E a Condução Do Estudounclassified

Estudo prospectivo aleatorizado comparando a eficiência clínica dos métodos convencional ou piggyback na drenagem venosa do fígado transplantado

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Domino Liver Transplantation With Double Piggyback: Is This the Best Technique? A Case Report

Cited by 8 publications

References 6 publications

Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient

Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient

Simplifying hepatic venous outflow reconstruction in sequential living donor liver transplantation

Estudo prospectivo aleatorizado comparando a eficiência clínica dos métodos convencional ou piggyback na drenagem venosa do fígado transplantado

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