Comparison of three caval reconstruction techniques in orthotopic liver transplantation: A retrospective review (original) (raw)
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Vena cava vascular reconstruction during orthotopic liver transplantation: A comparative study
Liver Transplantation and Surgery, 1998
The aim of this study was to evaluate the influence of preserving the recipient's inferior vena cava during orthotopic liver transplantation (OLT) on hemodynamic alterations, blood component requirements, postoperative liver and renal function, as well as vascular-related complications. A total of 122 OLTs was studied. In 35 OLTs, venovenous bypass (BP) was used; in 35 OLTs, bypass was not used (NBP); and in 52 OLTs, the recipient's inferior vena cava was preserved (PC). Preservation of the inferior vena cava means that venous return is not compromised at any time during transplantation. The time of hepatectomy was not different among the three groups (208 ؎ 11, 188 ؎ 13, and 194 ؎ 6 minutes for BP, NBP, and PC, respectively); however, the total operating time was significantly lower in PC pa-tients (492 ؎ 24, 459 ؎ 18, and 419 ؎ 10 minutes for BP, NBP, and PC, respectively; P ؍ .004, ANOVA). Blood component requirements were significantly lower in patients with PC. For red blood cells, these were 15.2 ؎ 2.6, 16 ؎ 3.4, and 7.1 ؎ 1.5 units for BP, NBP, and PC, respectively (P ؍ .009, ANOVA), and for fresh-frozen plasma, these were 5.4 ؎ .7, 5.8 ؎ .9, and 3 ؎ .4 L for BP, NBP, and PC, respectively (P ؍ .005, ANOVA). Postoperative liver and renal function did not differ among the three groups. The incidence of surgical complications (bleeding and vascular) was similar. Preservation of the inferior vena cava of the recipient significantly reduces the magnitude of OLT.
Transplantation Proceedings, 2011
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 ϭ 135), PB (n ϭ 32) and LLPB (n ϭ 33).
Clinical Transplantation, 2004
The aim of this study is to analyse a single centre's experience with two techniques of liver transplantation (OLT), conventional (CON-OLT) and piggyback (PB-ES), and to compare outcome in terms of survival, morbidity, mortality and post-operative liver function as well as operative characteristics. A consecutive series (1994)(1995)(1996)(1997)(1998)(1999)(2000) of 167 adult primary OLT were analysed. Ninety-six patients had CON-OLT and 71 patients had PB-ES. In the PB-ES group two revascularization protocols were used. In the first protocol reperfusion of the graft was performed first via the portal vein followed by the arterial anastomosis (PB-seq). In the second protocol the graft was reperfused simultaneously via portal vein and hepatic artery (PB-sim). One-, 3-and 5-yr patient survival in the CON-OLT and PB-ES groups were 90, 83 and 80%, and 83, 78 and 78%, respectively (p=ns). Graft survival at the same time points was 81, 73 and 69%, and 78, 69 and 65%, respectively (p=ns). Apart from the higher number of patients with cholangitis and sepsis in CON-OLT group, morbidity, retransplantation rate and post-operative liver and kidney function were not different between the two groups. The total operation time was not different between both groups (9.4 h in PB-ES vs. 10.0 h in CON-OLT), but in PB-ES group cold and warm ischaemia time (CIT and WIT), revascularization time (REVT), functional and anatomic anhepatic phases (FAHP and AAHP) were significantly shorter (8.9 h vs. 10.7 h, 54 min vs. 63 min, 82 min vs. 114 min, 118 min vs. 160 min and 87 min vs. 114 min, respectively, p < 0.05). RBC use in the PB-ES group was lower compared to the CON-OLT group (4.0 min vs. 10.0 units, p < 0.05). Except for WIT and REVT there were no differences in operative characteristics between PB-Sim and PB-Seq groups. The WIT was significantly longer in PB-Sim group compared with PB-Seq group (64 min vs. 50 min, p < 0.05); however REVT was significantly shorter in PB-Sim group (64 min vs. 97 min, p < 0.05). Results of this study show that both techniques are comparable in survival and morbidity; however PB-ES results in shorter AAHP, FAHP, REVT and WIT as well as less RBC use. In the PB-ES group there seems to be no advantage for any of the revascularization protocols.
Different cava reconstruction techniques in liver transplantation: piggyback versus cava resection
Hepatobiliary & Pancreatic Diseases International, 2014
BACKGROUND: Originally, cava reconstruction (CR) in liver transplantation meant complete resection and reinsertion of the donor cava. Alternatively, preservation of the recipients inferior vena cava (IVC) with side-to-side anastomosis (known as "piggyback") can be performed. Here, partial clamping maintains blood flow of the IVC, which may improve cardiovascular stability, reduce blood loss and stabilize kidney function. The aim of this study was to compare both techniques with particular focus on kidney function.
Impact of the venting via vena cava inferior on the outcome of liver transplantation
Bratislava Medical Journal, 2020
BACKGROUND: The liver transplantation is a standard treatment method for the indicated group of patients with a fi nal hepatic failure. Th e aim of this paper was to compare two reperfusion methods of implanted liver, non-venting and venting vena cava, and to evaluate the impact of both techniques on the post reperfusion syndrome. METHODS: We compared two groups of patients: non-venting (n = 42) and venting (n = 41). We monitored bilirubin, liver enzymes and hemodynamic changes after reperfusion. We recorded monitored parameters immediately prior to the transplantation, during and after the reperfusion and on the 1st postoperative day. All liver grafts were used from the donors after a brain death. RESULTS: We did not fi nd a statistically signifi cant difference in input monitored parameters. We detected signifi cant changes of pH after reperfusion in both monitored groups. We determined a signifi cantly better saturation in the non-venting group, bigger consumption of fresh frozen plasma and thrombo-concentrate in the non-venting group, a signifi cantly higher value of total bilirubin and a lower value of Quick's time in the non-venting group. CONCLUSION: Venting via vena cava inferior did not impact the perioperative and early postoperative course of liver transplantation in our group of patients. However, further analyses are required (Tab. 2, Fig. 3, Ref. 20).
Transplant International, 2010
The pros and cons of venovenous bypass (VVB) in adult liver transplantation (LT) have often been debated [1], especially when comparing the classic retrohepatic caval resection technique (RCR) [2] with VVB to the retrohepatic caval preservation technique, or 'piggyback' technique (PB) [3] without VVB. A recent comprehensive review of the reported benefits and drawbacks of VVB in modern adult LT confirms the existence of the controversy, which is testified by the great diversity among centers in their use of VVB [4]. The reported advantages of PB without VVB include: shorter surgical time [5], shorter anhepatic phase [5], shorter warm ischemic time [6,7], reduction in blood products transfused [6,7], and lower total cost of the operative procedure [6,7]. The question remains whether these reported benefits are attributed solely to the difference in the implantation technique (PB versus RCR) or due to the elimination of VVB. The main goal of this retrospective analysis was to elucidate the individual clinical impact of PB and that of the elimination of VVB, respectively, on the outcomes of adult patients who underwent LT. Methods After the approval of the local institutional review board (IRB), the prospectively recorded clinical and laboratory data was reviewed and analyzed in a retrospective fashion.
The Open Transplantation Journal, 2009
This study aimed to compare the piggyback technique with and without inferior vena cava cross-clamping (IVC-CC). Between 2002 and 2005 at two Hospitals in Brazil, 136 patients were submitted to orthotopic liver transplant (OLT), but 36 were excluded due to the employment of different techniques. Depending on the piggyback technique employed, the remaining 100 patients were divided into two groups: Group A (with IVC-CC) = 47 patients; and Group B (without IVC-CC) = 53 patients. The study revealed that the OLT using piggyback with IVC-CC took less time (1.39 hours) and required less blood transfusion, however a higher dosis of noradrenaline administration was necessary. No statistical differences were observed between the two groups regarding hemodynamic parameters during the surgery, or any impairment of the kidney and liver functions in the early post-operative period. In conclusion, the piggyback with IVC-CC required less surgical time and less units of blood transfusion.
Orthotopic Liver Transplantation with Preservation of the Inferior Vena Cava
Annals of Surgery, 1989
Piggyback orthotopic liver transplantation was performed in 24 patients during a period of 4 months. This represented 19% of the liver transplantations at our institution during that time. The piggyback method of liver insertion compared favorably with the standard operation in terms of patient survival, blood loss, incidence of vascular and biliary complications, and rate of retransplantation. The piggyback operation cannot be used in all cases, but when indicated and feasible its advantages are important enough to warrant its inclusion in the armamentarium of the liver transplant surgeon.
Langenbeck's Archives of Surgery, 2000
Background and aims: The potential advantages of vena cavapreserving recipient hepatectomy in orthotopic liver transplantation are reduced hemorrhage, improved cardiovascular stability and preserved renal perfusion without the requirement of veno-venous bypass as compared with recipient hepatectomy including the vena cava. No detailed information is available on the use of veno-venous bypass during complicated vena cava preserving recipient hepatectomy and liver transplantation. In the present study, the periand postoperative courses of adult liver transplant recipients in whom