title: Four hundred and twenty-three consecutive adults piggy-back liver transplantations with the three suprahepatic veins: was the portal systemic shunt required?
abstract: OBJECTIVE
  The aim of this study is to analyze a single-center experience in orthotopic liver transplantation with the piggy-back technique (PB) realized with a cuff of three veins without temporary portacaval shunt. Outcome parameters were graft and patient survival and the surgical complications.
  
  
  METHODS
  The records of 423 liver transplantation in 396 adult recipients were reviewed. PB was performed in all cases also in patients with transjugular intrahepatic portosystemic shunts and redo transplants without temporary portacaval shunt. No hemodynamic instability was observed during venous reconstruction.
  
  
  RESULTS
  Operation time, cold ischemia time and anhepatic phase were, respectively, 316, 606 and 82 min, respectively. The mean intraoperative transfusion of packed red blood cells was 3.2 (range 1-48). Surgical complications were observed in 25% of the orthotopic liver transplantation and 2% of these was related to caval anastomosis. No case of caval thrombosis was observed; a stenosis was noted in seven patients, always treated with an endovascular approach. A postoperative ascites was observed in seven cases. Retransplantation was required in 6.3% patients. Overall in-hospital mortality was 5.3%, but no patient died through technical problems or complications related to PB procedure. One-, 3- and 5-year grafts and patients were 94%, 83% and 75%, and 92%, 86% and 79%, respectively.
  
  
  CONCLUSIONS
  This experience indicates that our approach is feasible with a low specific risk and can be performed without portacaval shunt, with minimal outflow venous complications.
authors.affiliation: Department of Surgery, Multivisceral Transplant Centre, Hopital Hautepierre, University of Strasbourg, Strasbourg, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Audet
authors.forename: Tullio
authors.initials: T
authors.lastname: Piardi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Panaro
authors.forename: Murat
authors.initials: M
authors.lastname: Cag
authors.forename: Hussein
authors.initials: H
authors.lastname: Habibeh
authors.forename: Federico
authors.initials: F
authors.lastname: Gheza
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.forename: Jacques
authors.initials: J
authors.lastname: Cinqualbre
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaeck
authors.forename: Philippe
authors.initials: P
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome