Could the Piggyback Operation in Liver Transplantation Be Routinely Used?

Abstract

Objective: To determine if orthotopic liver transplantation with inferior vena cava preservation, performed without using caval cross clamping or venovenous bypass, can minimize hemodynamic instability and low renal perfusion pressure. Design: A prospective case series of 44 consecutive adult orthotopic liver transplantations, with a maximum follow-up of 30 months. Setting: An institutional university referral center. Patients: Between November 1990 and May 1993, 39 consecutive adult liver transplant recipients underwent transplantation with the following primary diagnoses: alcoholic cirrhosis (n=23), viral cirrhosis (n=9), primary biliary cirrhosis (n=2), Wilson's disease (n=2), primary sclerosing cholangitis (n=1), fulminant hepatic failure (n=1), and secondary hepatic malignant neoplasm (n=1); five had repeated orthotopic liver transplantation. Intervention: Orthotopic liver transplantations were performed using the piggyback technique, but with placement of the vascular clamp on the inferior vena cava laterally instead of across it so that it remained patent throughout the anhepatic stage. Favorable anatomic conditions in the recipients were not considered; venovenous bypass was not used. Main Outcome Measures: Intraoperative hemodynamic profile, blood loss and replacement, surgical time and complications, and patient survival. Results: No significant hemodynamic changes with lateral clamping and no increases in surgical complications, rate of retransplantation, blood product requirements, or survival rate compared with the standard procedure. Conclusion: The piggyback operation could be routinely used in orthotopic liver transplantation. (Arch Surg. 1994;129:842-845)