title: Conventional versus piggyback technique of caval implantation; without extra-corporeal veno-venous bypass. A comparative study.
abstract: Conventional orthotopic liver transplantation (CON-LT) involves resection of recipient cava, usually with extra-corporeal circulation (veno-venous bypass, VVB), while in the piggyback technique (PC-LT) the cava is preserved. Along with a temporary portacaval shunt (TPCS), better haemodynamic maintenance is purported with PC-LT. A prospective, consecutive series of 384 primary transplants (2000-2003) were analysed, 138 CON-LT (with VVB) and 246 PC-LT (54 without TPCS). Patient/donor characteristics were similar in the two groups. PC-LT required less usage of fresh-frozen plasma and platelets, intensive care stay, number of patients requiring ventilation after day 1 and total days spent on ventilator. The results were not different when comparing, total operating and warm ischaemia time (WIT), red cell usage, requirement for renal support, day 3 serum creatinine and total hospital stay. TPCS had no impact on outcome other than WIT (P = 0.02). Three patients in PC-LT group (three of 246;1.2%) developed caval outflow obstruction (P = 0.02). There was no difference in short- or long-term graft or patient survival. PC-LT has an advantage over CON-LT unsing VVB with respect to intraoperative blood product usage, postoperative ventilation requirement and ITU stay. VVB is no longer required and TPCS may be used selectively in adult transplantation.
authors.affiliation: Liver Unit (Liver Transplantation and Hepatobiliary Surgery), University Hospital Birmingham NHS Trust, Queen Elizabeth, Edgbaston, Birmingham, UK.
authors.forename: Saboor
authors.initials: S
authors.lastname: Khan
authors.forename: Michael A
authors.initials: MA
authors.lastname: Silva
authors.forename: Yu Meng
authors.initials: YM
authors.lastname: Tan
authors.forename: Abraham
authors.initials: A
authors.lastname: John
authors.forename: Bridget
authors.initials: B
authors.lastname: Gunson
authors.forename: John A C
authors.initials: JA
authors.lastname: Buckels
authors.forename: A
authors.initials: A
authors.lastname: David Mayer
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bramhall
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014682:Vena Cava, Inferior / Q000601:surgery*