title: Does caval reconstruction technique affect early graft function after liver transplantation? A preliminary analysis.
abstract: BACKGROUND
  In the past decades, the inferior vena cava (IVC) reconstruction technique has undergone several evolutions, such as biopump, piggyback technique (PB), and laterolateral approach (LLPB). Several advantages are reported comparing the PB technique to biopump use. However, comparison between PB and LLPB has not been as well investigated. The aim of this study was to compare the results in terms of immediate graft function and intermediate graft survival among 3 subgroups characterized by distinct caval reconstruction techniques.
  
  
  METHODS
  We retrospectively analyzed a cohort of 200 consecutive adult patients who underwent liver transplantation from January 2001 to December 2009. The patients were stratified according to 3 caval reconstructive techniques: biopump (n=135), PB (n=32) and LLPB (n=33).
  
  
  RESULTS
  The LLPB group showed the shortest cold and warm ischemia times and the best immediate postoperative graft function. Survival analysis revealed LLPB patients to present the best 1-year graft survival rates: namely, 90.9% versus 75.0% and 74.1% among the PB and biopump groups, respectively (log-rank tests: LLPB vs biopump: P=.03; LLPB vs PB: P=.05). In our experience, LLPB showed the best graft survivals with an evident reduction in both cold and warm ischemia times. However, it is hard to obtain an irrefutable conclusion owing to the retrospective nature of this study, the small sample, and the different periods in which the groups were transplanted.
  
  
  CONCLUSIONS
  LLPB technique was a safe procedure that minimized the sequelal of ischemia-reperfusion damage. This technique yielded results superior to venovenous bypass. No definitive conclusions can to be obtained in this study comparing classic PB or LLPB.
authors.affiliation: Department of General Surgery and Organ Transplantation, Sapienza University, Rome, Italy. lai.quirino@libero.it
authors.forename: Q
authors.initials: Q
authors.lastname: Lai
authors.forename: F
authors.initials: F
authors.lastname: Nudo
authors.forename: A
authors.initials: A
authors.lastname: Molinaro
authors.forename: G
authors.initials: G
authors.lastname: Mennini
authors.forename: G
authors.initials: G
authors.lastname: Spoletini
authors.forename: F
authors.initials: F
authors.lastname: Melandro
authors.forename: N
authors.initials: N
authors.lastname: Guglielmo
authors.forename: L
authors.initials: L
authors.lastname: Parlati
authors.forename: M
authors.initials: M
authors.lastname: Mordenti
authors.forename: S
authors.initials: S
authors.lastname: Ginanni Corradini
authors.forename: P B
authors.initials: PB
authors.lastname: Berloco
authors.forename: M
authors.initials: M
authors.lastname: Rossi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D050377:Cold Ischemia; D005260:Female; D006085:Graft Survival; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014682:Vena Cava, Inferior / Q000601:surgery*; D052096:Warm Ischemia; D055815:Young Adult