Four hundred and twenty‐three consecutive adults piggy‐back liver transplantations with the three suprahepatic veins: Was the portal systemic shunt required?

Abstract

This experience indicates that our approach is feasible with a low specific risk and can be performed without portacaval shunt, with minimal outflow venous complications.

Optimizing outflow in piggyback liver transplantation without caval occlusion: The three-vein technique

“…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.…”

Vascular complications following liver transplantation: A literature review of advances in 2015

“…Currently, transplant outflow obstruction by kinking, stenosis or thrombosis of the inferior vena cava (IVC) or hepatic vein, especially in LDLT, are relatively un common complications following liver transplantation with an reported incidence of less than 3% [94,95] (Table 8 and Figure 5). Clinical presentation ranges from lower limb edema, hepatomegaly, ascites, pleural effusions, BuddChiari syndrome, liver and renal failure to hypotension leading to allograft loss and multiorgan failure [4,89,135] .…”

“…The preservation of the recipient IVC with the PB technique has been associated with an increased risk of suprahepatic IVC thrombosis or stenosis, leading to acute or chronic BuddChiari syndrome in 0% to 1.6%, venous congestion of the liver allograft in 1%, and with an increased incidence of posttransplant ascites [89,135] . To avoid such complications, techniques for optimizing outflow with the piggyback technique have been described; the main of these in undoubtfully the width of the caval anastomosis, while other authors have reported methods using either the twovein or the threevein technique for anastomosis with a low rate of CACs [89,94,135,145149] . Finally, several studies have demonstrated the superiority of modifiedPB with the threehepatic vein technique, which should be routinely used in OLT because it is safe and efficient and invo lves few surgical complications [89,94,143] .…”

“…To avoid such complications, techniques for optimizing outflow with the piggyback technique have been described; the main of these in undoubtfully the width of the caval anastomosis, while other authors have reported methods using either the twovein or the threevein technique for anastomosis with a low rate of CACs [89,94,135,145149] . Finally, several studies have demonstrated the superiority of modifiedPB with the threehepatic vein technique, which should be routinely used in OLT because it is safe and efficient and invo lves few surgical complications [89,94,143] . Hepatic venous stenosis is specific to LDLT with an incidence of 2% to 4%, because of the different techniques of donor graft outflow venoplasty, leading to Budd-Chiari syndrome or outflow block syndrome after LDLT [150] .…”

“…Venous complications following OLT include: Portal (1%-3%) and caval (< 2%) problems [5,8,9,91] . The etiology underlying most of these involves the anastomosis, including: (1) PVT: < 3% (the most pejorative), portal vein stenosis (PVS): 2%-3%; and (2) caval and hepatic veins with specific complications depending to the type of anastomosis either end to end caval anastomosis: Thrombosis, stenosis (< 2%); or piggyback: Thrombosis, stenosis, kinking < 2% [4,5,8,9,91,94,95] . In the same fashion as HACs, they can be classified into two categories (Table 1): Early (< 1 mo) or late (delayed, i.e., > 1 mo).…”