Infrahepatic Terminolateral Cavo–Cavostomy as a Rescue Technique in Complicated “Modified” Piggyback Liver Transplantation

Merenda, Roberto; Gerunda, Giorgio Enrico; Neri, Daniele; Barbazza, F.; Marzio, Enrico Di; Bruttocao, A; Valmasoni, Michele; Angeli, Paolo; Faccioli, Alvise Maffei

doi:10.1016/s1072-7515(97)00101-4

Cited by 18 publications

(13 citation statements)

References 7 publications

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“…Nevertheless, the classical PB technique can be associated with some disadvantages and complications, including hepatic venous outflow obstruction11, 37, 38 and thrombosis in up to 10%, because of the inappropriate size of the hepatic vein outlet, which results in venous congestion of the liver allograft. This congestion increases the chance of posttransplant ascites and Budd‐Chiari syndrome,16, 17, 23, 33, 39–41 as evaluated by Cescon et al11 in a retrospective study of venous outflow reconstruction in 431 recipients with an incidence of 4.6%.…”

Section: Discussionmentioning

confidence: 99%

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

2011

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Head and neck squamous cell carcinoma (HNSCC) is one of many cancers that are strongly associated with tobacco use. Whereas HNSCC is often seen in tobacco users, many tobacco users do not develop carcinoma; and the differences between smokers with and without HNSCC are poorly studied to date. Some smokers may be inherently more susceptible to developing carcinoma due to patterns of tobacco use, innate metabolism of carcinogens, or altered excretion. Identifying those smokers at greatest risk for HNSCC would have great benefit through targeted smoking cessation efforts and enhanced surveillance. One approach to better understand the extent of exposure to, and metabolism of, tobacco carcinogens is through the use of tobacco-specific metabolites. Tobacco-specific metabolites can identify patterns of dose, exposure, and metabolism, and perhaps ultimately characterize the important differences between smokers who develop HNSCC and smokers who do not.

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Section: Discussionmentioning

confidence: 99%

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

2011

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“…During the last decade, various PB techniques have been proposed (two suprahepatic veins, latero-lateral, modified), but our technique of clamping exclusively the origin of the suprahepatic veins allows an improvement of intraoperative cardiac and hemodynamic stability by maintenance of venous return. Nevertheless, the classic PB can be associated with some disadvantages and complications, including hepatic venous outflow obstruction 18,19 and thrombosis in up to 10% of subjects, which results in venous congestion of the liver graft. Cescon et al 15 reported in a retrospective study of venous outflow reconstruction that the outflow complications correlated with the number of hepatic veins used and the diameter of the reconstructed orifice.…”

Section: Discussionmentioning

confidence: 99%

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

Audet

Piardi

Panaro

et al. 2010

J of Gastro and Hepatol

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“…17 The high rate of irreversible graft failure after venous outflow obstruction and total IVC clamping for revision of the caval anastomosis confirmed the poor tolerance for warm ischemia when superimposed on congestion. 18 As a consequence, efforts should be made to prevent venous outflow obstruction by performing a large caval anastomosis and avoid graft rotation by appropriate fixation. A study showed that performing caval anastomosis using the termination of the three native hepatic veins rather than the termination of the middle and left hepatic veins reduced the incidence of venous outflow obstruction after reperfusion from 6% to 1%.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and limits of caval-flow preservation during liver transplantation

Belghiti

2001

Liver Transplantation

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As promoters of orthotopic liver transplantation (OLT) with preservation of caval flow, we reviewed our 8-year experience to assess the feasibility and limits of this technique. Preservation of caval flow during OLT, which improves intraoperative hemodynamic stability, was not considered feasible in a significant proportion of transplant recipients. When transient clamping of caval flow is required, causes and consequences of this clamping during all phases of the procedure were not reported. Between 1991 and 1998, a total of 275 OLTs using a whole graft were performed in 259 patients with a policy consisting of a systematic attempt to preserve inferior vena cava ( P reservation of the inferior vena cava (IVC) during orthotopic liver transplantation (OLT), described by Calne and William 1 in 1968, was popularized in 1989 by Tzakis et al 2 as the piggyback procedure. It was advocated that the main advantages of this procedure were to avoid retrocaval dissection to reduce the risk for bleeding and facilitate caval anastomosis in patients receiving large-for-size grafts. 2,3 As originally described, this procedure was frequently performed using transient cross-clamping of the IVC, especially in the case of difficulty disconnecting the native liver from the retrohepatic IVC. 2 As a consequence, this procedure was frequently performed in conjunction with venovenous bypass, with the aim to overcome the hemodynamic consequences of IVC cross-clamping. 2 To avoid the need for venovenous bypass, we described in 1992 a modification of the piggyback technique in which caval flow was preserved throughout the OLT procedure. 4 This modification made preservation of IVC blood flow possible by performing either a sideto-side or end-to-side cavocaval anastomosis and using the middle and left hepatic cuff with partial IVC clamping at its anterior face. 5 In addition, splanchnic venous drainage could be maintained through a transient portocaval anastomosis. 5 Although this procedure was shown to help improve intraoperative hemodynamic stability, several investigators objected that it was not feasible in a significant proportion of transplant recipients. [6][7][8][9] Since 1991, we have attempted systematically to use the modified piggyback technique for all OLTs at our center. As promoters of this technique, we review our experience over the ensuing 8 years in an attempt to determine the feasibility of caval-flow preservation and report the rate, causes, and consequences of total IVC clamping.

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Infrahepatic Terminolateral Cavo–Cavostomy as a Rescue Technique in Complicated “Modified” Piggyback Liver Transplantation

Cited by 18 publications

References 7 publications

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

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

Feasibility and limits of caval-flow preservation during liver transplantation

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