title: Piggyback technique in adult orthotopic liver transplantation: an analysis of 1067 liver transplants at a single center.
abstract: BACKGROUND
  Orthotopic liver transplantation (OLT) in adult patients has traditionally been performed using conventional caval reconstruction technique (CV) with veno-venous bypass. Recently, the piggyback technique (PB) without veno-venous bypass has begun to be widely used. The aim of this study was to assess the effect of routine use of PB on OLTs in adult patients.
  
  
  METHODS
  A retrospective analysis was undertaken of 1067 orthotopic cadaveric whole liver transplantations in adult patients treated between June 1994 and July 2001. PB was used as the routine procedure. Patient demographics, factors including cold ischemia time (CIT), warm ischemia time (WIT), operative time, transfusions, blood loss, and postoperative results were assessed. The effects of clinical factors on graft survival were assessed by univariate and multivariate analyses.In all, 918 transplantations (86%) were performed with PB. Blood transfusion, WIT, and usage of veno-venous bypass were less with PB. Seventy-five (8.3%) cases with PB had refractory ascites following OLT (p=NS). Five venous outflow stenosis cases (0.54%) with PB were noted (p=NS). The liver and renal function during the postoperative periods was similar. Overall 1-, 3-, and 5-year patient survival rates were 85%, 78%, and 72% with PB. Univariate analysis showed that cava reconstruction method, CIT, WIT, amount of transfusion, length of hospital stay, donor age, and tumor presence were significant factors influencing graft survival. Multivariate analysis further reinforced the fact that CIT, donor age, amount of transfusion, and hospital stay were prognostic factors for graft survival.
  
  
  CONCLUSIONS
  PB can be performed safely in the majority of adult OLTs. Results of OLT with PB are as same as for CV. Liver function, renal function, morbidity, mortality, and patient and graft survival are similar to CV. However, amount of transfusion, WIT, and use of veno-venous bypass are less with PB.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Miami/Jackson Memorial Medical Center, Miami, FL, USA. snishida@med.miami.edu
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Noboru
authors.initials: N
authors.lastname: Nakamura
authors.forename: Anil
authors.initials: A
authors.lastname: Vaidya
authors.forename: David M
authors.initials: DM
authors.lastname: Levi
authors.forename: Tomoaki
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authors.lastname: Kato
authors.forename: Jose R
authors.initials: JR
authors.lastname: Nery
authors.forename: Juan R
authors.initials: JR
authors.lastname: Madariaga
authors.forename: Enrique
authors.initials: E
authors.lastname: Molina
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Anthony
authors.initials: A
authors.lastname: Gyamfi
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis