title: Infrahepatic vena cavocavostomy, a modification of the piggyback technique for liver transplantation.
abstract: We describe our experience with a modification of the piggyback (PB) technique for orthotopic liver transplantation in which the donor infrahepatic vena cava is used as the venous outflow tract. From May 1997 to January 2006, a total of 109 cases using this technique were performed in 101 patients. Collected data included recipient demographics and diagnosis, warm ischemia time, use of venovenous bypass or temporary portacaval shunt and complications related to the venous outflow and graft, and patient survival. Data were compared with the patients undergoing standard PB technique during the same period. The reasons for using the technique were grouped according to whether there was a problem with the recipient hepatic veins or a concern about the length or diameter of the donor suprahepatic vena cava. These included the presence of a transjugular intrahepatic portosystemic shunt (eight cases), retransplantation (22 cases), thin-walled, friable hepatic veins (32 cases), Budd-Chiari syndrome (two cases), domino liver procurement (six cases), reduced or split liver grafts (five cases), and graft inferior vena cava to recipient hepatic veins size discrepancy (34 cases). There was no graft loss. The warm ischemia time was 39.65 minutes compared with 37 minutes in the standard PB group. The long-term graft and patient survival rates were similar in the two groups. Infrahepatic vena cavocavostomy is a useful variation of the standard PB technique.
authors.affiliation: Department of Surgery, Division of Liver/GI Transplantation, University of Miami, Miller School of Medicine, Miami, Florida, USA. khanmok@einstein.edu
authors.forename: Kamran
authors.initials: K
authors.lastname: Khanmoradi
authors.forename: Werviston
authors.initials: W
authors.lastname: Defaria
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: David
authors.initials: D
authors.lastname: Levi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
authors.forename: Jang
authors.initials: J
authors.lastname: Moon
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.forename: Andreas
authors.initials: A
authors.lastname: Tzakis
mesh_terms: D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014684:Venae Cavae / Q000601:surgery*