title: Venous outflow reconstructions with the piggyback technique in liver transplantation: a single-center experience of 431 cases.
abstract: The ideal method of venous outflow reconstruction with the piggyback technique (PB) in orthotopic liver transplantation (OLT) is not well-established. The complications related to PB in 431 primary OLTs were analyzed comparing the orifices used for the anastomosis (cuff of the recipient left and middle hepatic veins [LM], LM with a >1 cm cavoplasty [LM+], or also including the right hepatic vein [LMR]). Treatment strategies and outcome were also evaluated. Twenty patients (4.6%) experienced complications: 13 of 120 (10.8%) with LM, four of 225 (1.8%) with LM+, and three of 86 (3.5%) with LMR (LM versus LM+: P < 0.0001; LM versus LMR: P = NS; LM+ versus LMR = NS). Balloon dilation was successful in 10 of 13 cases in which it was attempted (77%). Eight patients required retransplantation (40%). Three patients (0.7%) died from causes linked to stenosis. Five-year survival of patients with and without complications was 75% and 79%, respectively (P =NS); 5-year graft survival was 50% and 76%, respectively (P = 0.001). The stump formed by the recipient left and middle hepatic veins with a transversal incision >1 cm of the caval wall constantly provides an adequate width for the caval anastomosis with the PB.
authors.affiliation: Department of Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Varotti
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Andrea
authors.initials: A
authors.lastname: Gardini
authors.forename: Antonino
authors.initials: A
authors.lastname: Cavallari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies