Piggy-back versus conventional technique in liver transplantation: report of a randomized trial.
Liver transplantation with preservation of the recipient vena cava (the "piggy-back" technique) has been proposed as an alternative to the traditional method. We performed a randomized study on 39 cirrhotic patients, 20 who underwent the piggy-back technique (group 1) and 19 the traditional method using venovenous bypass (group 2) to evaluate the feasibility and true advantages of the piggy-back technique compared to the traditional method. Two patients were switched to the conventional technique due to the presence of a caudate lobe embracing the vena cava in one patient and a caval lesion in the other. Statistically significant differences between the two groups were only found for the warm ischemia time (48.5 +/- 13 min for piggy-back vs 60 +/- 12 min for the conventional method) and for renal failure (zero cases in group 1 vs four cases in group 2). We therefore believe that liver transplantation with the piggy-back technique can easily be performed in almost all cases, and that only a few, specific situations, such as a very enlarged caudate lobe, do not justify its routine use.
Jovine
E
E
Second Department of Surgery, University of Bologna, Policlinico S. Orsola, Italy.
Mazziotti
A
A
Grazi
G L
GL
Ercolani
G
G
Masetti
M
M
Morganti
M
M
Pierangeli
F
F
Begliomini
B
B
Mazzetti
P G
PG
Rossi
R
R
Paladini
R
R
Cavallari
A
A
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D017707:Erythrocyte Transfusion; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006527:Hepatolenticular Degeneration / Q000601:surgery; D006801:Humans; D007511:Ischemia; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation