End-to-side caval anastomosis in adult piggyback liver transplantation.
No consensus exists regarding the optimal reconstruction of the cavo-caval anastomosis in piggyback orthotopic liver transplantation (PB-LT). The aim of this study was to analyze our experience with end-to-side (ES) cavo-cavostomy. Outcome parameters were patient and graft survival and surgical complications. During the period 1995-2002 146 full-size PB-LT in 137 adult patients were performed with ES cavo-cavostomy without the routine use of temporary portocaval shunt (TPCS). In 12 patients (8%) this technique was used for implantation of second or third grafts. Veno-venous bypass was not used in any case and TPCS was performed only in eight patients (6%). One-, three- and five-yr patient and graft survival were 84%, 79% and 75%, and 81%, 74% and 69%, respectively. The median number of intraoperative transfusion of packed red blood cells (RBC) was 2.0 (range 0-33) and 30% of the patients (n = 43) did not require any RBC transfusion. Surgical complications of various types were observed after 49 LT (34%) and none of the complications was specifically related to the technique of ES cavo-cavostomy. Our experience indicates that PB-LT with ES cavo-cavostomy is a safe procedure, can safely be performed without the routine use of a TPCS, has a very low risk of venous outflow obstruction and can also be used effectively during retransplantations.
Polak
Wojciech G
WG
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Nemes
Balazs A
BA
Miyamoto
Shungo
S
Peeters
Paul M J G
PM
de Jong
Koert P
KP
Porte
Robert J
RJ
Slooff
Maarten J H
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D017707:Erythrocyte Transfusion; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D011183:Postoperative Complications; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*