Vascular complications following adult piggyback liver transplantation with end-to-side cavo-cavostomy: a single-center experience.
BACKGROUND
Vascular complications remain a significant cause of morbidity, graft loss, and mortality following orthotopic liver transplantation (OLT). These problems predominantly include hepatic artery and portal vein thrombosis or stenosis. Venous outflow obstruction may be specifically related to the technique of piggyback OLT.


METHODS
Between February 2002 and February 2009, we performed 200 piggyback OLT in 190 recipients. A temporary portacaval shunt was created in 44 (22%) cases, whereas end-to-side cavo-cavostomy was routinely performed for graft implantation. Pre-existent partial portal or superior mesenteric vein thrombosis was present in 17 (12%) cirrhotics in whom we successfully performed eversion thrombectomy, which was followed by a typical end-to-end portal anastomosis. The donor hepatic artery was anastomosed to the recipient aorta via an iliac interposition graft in 31 (16%) patients.


RESULTS
The 14 (7%) vascular complications included hepatic artery thrombosis (n = 5), hepatic artery stenosis (n = 3), aortic/celiac trunk rupture (n = 2), portal vein stenosis (n = 2), and isolated left and middle hepatic venous outflow obstruction (n = 1). There was also 1 case of arterial steal syndrome via the splenic artery. No patient experienced portal or mesenteric vein thrombosis. Therapeutic modalities included re-OLT, arterial/aortic reconstruction and splenic artery ligation. Vascular complications resulted in death of 5 (36%) patients.


CONCLUSIONS
Our experience indicated that piggyback OLT with an end-to-side cavo-cavostomy showed a low risk of venous outflow obstruction. Partial portal or mesenteric vein thrombosis is no longer an obstacle to OLT; it can be successfully managed with the eversion thrombectomy technique.
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Marie Curie Hospital, ul. Arkonska 4; 71-455 Szczecin, Poland. drmwojcicki@wp.pl
M
M
Wojcicki
M
M
Post
M
M
Pakosz-Golanowska
S
S
Zeair
J
J
Lubikowski
K
K
Jarosz
M
M
Czuprynska
P
P
Milkiewicz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D001219:Aspartate Aminotransferases / Q000097:blood; D002102:Cadaver; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D014019:Tissue Donors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
D001219:Aspartate Aminotransferases