title: Reconstruction of the hepatic venous outflow in piggyback liver transplantation.
abstract: OBJECTIVE
  The "piggyback" hepatic vein reconstruction and orthotopic liver transplantation (PBOLT) is a technique of liver transplantation that leaves the recipient inferior vena cava (IVC) intact, often avoiding the use of venovenous bypass (VVBP). Our study investigated whether patient morbidity and mortality after PB-OLT was comparable to that of the standard technique of orthotopic liver transplant (STD-OLT), which generally requires VVBP.
  
  
  METHODS
  We reviewed 220 consecutive adult OLTs performed at a single institution. In the PB-OLT technique, the IVC was left intact. The suprahepatic IVC was anastomosed to a cuff, fashioned from the confluence of the recipient left and middle hepatic veins. The donor infrahepatic IVC was oversewn. The STD-OLT technique was used when patient conditions precluded PB-OLT. VVBP was required in 83% of STD-OLT cases and no cases of PB-OLT.
  
  
  RESULTS
  PB-OLT was successfully performed in 122 of the 220 patients (55.5%), and STD-OLT was performed in 98 patients (44.5%). The 1- and 3-year survival rates, 96.3% and 87.8% vs 96.7% and 84.0% for PB-OLT and STD-OLTs, respectively, did not differ significantly. Total ischemic time and length of posttransplant hospital stay were shorter in the PB-OLT group. The total operative time and red cell transfusion requirements were comparable. The rate of suprahepatic IVC-related complications did not differ between the two groups, and no VVBPrelated complications were seen.
  
  
  CONCLUSIONS
  The PB-OLT can be used to avoid VVBP and its attendant risks in the majority of patients undergoing OLT. In the current era of transplantation, the PB-OLT should be considered a safe technique for OLT.
authors.affiliation: Michael E DeBakey Department of Surgery, Baylor College of Medicine, 6550 Fannin, Houston, TX 77030, USA.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
authors.forename: Timothy
authors.initials: T
authors.lastname: Lee
authors.forename: Murat
authors.initials: M
authors.lastname: Kiliç
authors.forename: John A
authors.initials: JA
authors.lastname: Goss
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures