Liver transplantation with preservation of the inferior vena cava. A comparison of conventional and piggyback techniques in adults

Abstract

Liver transplantation with preservation of the inferior vena cava. A comparison of conventional and piggyback techniques in adults Conventional orthotopic liver transplantation (CON-OLT) with resection of the native liver of the recipient together with the retrohepatic inferior vena cava (IVC) and interposition of the donor IVC attached to the new graft, has been the most common surgical approach in liver transplantation Miyamoto S, Polak WG, Geuken E, Peeters PMJG, de Jong KP, Porte RJ, van den Berg AP, Hendriks HG, Slooff MJH. Liver transplantation with preservation of the inferior vena cava. A comparison of conventional and piggyback techniques in adults.Abstract: The aim of this study is to analyse a single centre's experience with two techniques of liver transplantation (OLT), conventional (CON-OLT) and piggyback (PB-ES), and to compare outcome in terms of survival, morbidity, mortality and post-operative liver function as well as operative characteristics. A consecutive series (1994)(1995)(1996)(1997)(1998)(1999)(2000) of 167 adult primary OLT were analysed. Ninety-six patients had CON-OLT and 71 patients had PB-ES. In PB-ES group two revascularization protocols were used. In the first protocol reperfusion of the graft was performed first via the portal vein followed by the arterial anastomosis (PB-seq). In the second protocol the graft was reperfused simultaneously via portal vein and hepatic artery (PB-sim). One-, 3-and 5-yr patient survival in the CON-OLT and PB-ES groups were 90, 83 and 80%, and 83, 78 and 78%, respectively (p ¼ ns). Graft survival at the same time points was 81, 73 and 69%, and 78, 69 and 65%, respectively (p ¼ ns). Apart from the higher number of patients with cholangitis and sepsis in CON-OLT group, morbidity, retransplantation rate and post-operative liver and kidney function were not different between the two groups. The total operation time was not different between both groups (9.4 h in PB-ES vs. 10.0 h in CON-OLT), but in PB-ES group cold and warm ischaemia time (CIT and WIT), revascularization time (REVT), functional and anatomic anhepatic phases (FAHP and AAHP) were significantly shorter (8.9 h vs. 10.7 h, 54 min vs. 63 min, 82 min vs. 114 min, 118 min vs. 160 min and 87 min vs. 114 min, respectively, p < 0.05). RBC use in the PB-ES group was lower compared to the CON-OLT group (4.0 min vs. 10.0 units, p < 0.05). Except for WIT and REVT there were no differences in operative characteristics between PB-Sim and PB-Seq groups. The WIT was significantly longer in PB-Sim group compared with PB-Seq group (64 min vs. 50 min, p < 0.05); however REVT was significantly shorter in PB-Sim group (64 min vs. 97 min, p < 0.05). Results of this study show that both techniques are comparable in survival and morbidity; however PB-ES results in shorter AAHP, FAHP, REVT and WIT as well as less RBC use. In the PB-ES group there seems to be no adavantage for any of the revascularization protocols.

Improving Outcomes of Liver Retransplantation: An Analysis of Trends and the Impact of Hepatitis C Infection

“…These decreases may reflect improving surgical techniques such as preservation of the vena cava and possibly more widespread surgical experience leading to Improving Outcomes of Liver Retransplantation improved immediate postoperative outcomes. In both this study and others, prolonged WIT was demonstrated to be a strong independent predictor of graft and patient survival (15)(16)(17)(18). Arguably RT WIT would be minimized at centers with higher transplant volumes and experience with the …”

Reducing transfusion requirements in liver transplantation

“…A favourable cardiovascular status may facilitate anaesthetic strategies to maintain low central venous pressure (CVP) and indirectly contribute to reduced blood loss [56] . There are inconsistent reports of the blood conserving efficacy of the technique [57,58] . A Cochrane review found no difference in transfusion requirement between piggyback and classical groups (SMD -0.09; 95%CI: -0.47 to 0.29; P = 0.65) [59] .…”

Heme Oxygenase-1 Genotype of the Donor Is Associated With Graft Survival After Liver Transplantation

“…A standardized technique was used for implantation, as has been described previously (23,24). During the study period, immunosuppressive protocols were based on tacrolimus or cyclosporine A, either with or without azathioprine and a rapid taper of steroids.…”