Venous outflow reconstructions with the piggyback technique in liver transplantation: A single-center experience of 431 cases

Matteo Cescon, Gian Luca Grazi, Giovanni Varotti, Matteo Ravaioli, Giorgio Ercolani, Andrea Gardini, Antonino Cavallari

Research output: Contribution to journalArticle

Abstract

The ideal method of venous outflow reconstruction with the piggyback technique (PB) in orthotopic liver transplantation (OLT) is not well-established. The complications related to PB in 431 primary OLTs were analyzed comparing the orifices used for the anastomosis (cuff of the recipient left and middle hepatic veins [LM], LM with a > 1 cm cavoplasty [LM+], or also including the right hepatic vein [LMR]). Treatment strategies and outcome were also evaluated. Twenty patients (4.6%) experienced complications: 13 of 120 (10.8%) with LM, four of 225 (1.8%) with LM+, and three of 86 (3.5%) with LMR (LM versus LM+: P <0.0001; LM versus LMR: P = NS; LM+ versus LMR = NS). Balloon dilation was successful in 10 of 13 cases in which it was attempted (77%). Eight patients required retransplantation (40%). Three patients (0.7%) died from causes linked to stenosis. Five-year survival of patients with and without complications was 75% and 79%, respectively (P =NS); 5-year graft survival was 50% and 76%, respectively (P = 0.001). The stump formed by the recipient left and middle hepatic veins with a transversal incision > 1 cm of the caval wall constantly provides an adequate width for the caval anastomosis with the PB.

Original languageEnglish
Pages (from-to)318-325
Number of pages8
JournalTransplant International
Volume18
Issue number3
DOIs
Publication statusPublished - Mar 2005

Keywords

  • Liver
  • Orthotopic
  • Piggyback
  • Transplantation

ASJC Scopus subject areas

  • Transplantation

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