Piggyback technique in adult orthotopic liver transplantation: an analysis of 1067 liver transplants at a single center

Abstract

The technique of orthotopic liver transplantation (OLT) has been evolving since its introduction in 1963 [ 1 x [1] Starzl, T.E., Marchioro, T.L., Von Kaulla, K.N., Hermann, G., Brittain, R.S., and Waddell, W.R. Homotransplantation of the liver in humans. Surg Gynecol Obstet. 1963; 117: 659–676 PubMed | Google Scholar See all References , 2 x [2] Calne, R.Y. and Williams, R. Liver transplantation in man-I, observations on technique and organization in five cases. BMJ. 1968; 4: 535–540 Crossref | PubMed | Scopus (216) | Google Scholar See all References , 3 x [3] Caline, R.Y., Williams, R., Dawson, J.L., Ansell, I.D., Evans, D.B., and Flute, P.T. Liver transplantation in man-II, a report of two orthotopic liver transplants in adult recipients. BMJ. 1968; 4: 541–546 PubMed | Google Scholar See all References ]. Vascular reconstruction has played a major role in this procedure [ 4 x [4] Goldstein, R.M., Secrest, C.L., Klintmalm, G.B., and Husberg, B.S. Problematic vascular reconstruction in liver transplantation. Part I. Arterial. Surgery. 1990; 107: 540–543 PubMed | Google Scholar See all References , 5 x [5] Kirsch, J.P., Howard, T.K., Klintmalm, G.B., Husberg, B.S., and Goldstein, R.M. Problematic vascular reconstruction in liver transplantation. Part II. Portovenous conduits. Surgery. 1990; 107: 544–548 PubMed | Google Scholar See all References ]. During the anhepatic phase there are hemodynamic issues that affect morbidity, mortality, and the entire transplant course. Traditionally, OLT in adult patients has been performed using the conventional caval reconstruction technique (CV) with veno-venous bypass [ 6 x [6] Shaw, B.W., Martin, D.J., Marquez, J.M., Kang, Y.G., Bugbee, A.C. Jr, and Iwatsuki, S. Venous bypass in clinical liver transplantation. Ann Surg. 1984; 200: 524–534 Crossref | PubMed | Google Scholar See all References ] [6] . CV involves recipient hepatectomy including the retrohepatic vena cava [ 1 x [1] Starzl, T.E., Marchioro, T.L., Von Kaulla, K.N., Hermann, G., Brittain, R.S., and Waddell, W.R. Homotransplantation of the liver in humans. Surg Gynecol Obstet. 1963; 117: 659–676 PubMed | Google Scholar See all References ] [1] . CV has been a reliable and standard technique. However, hypotension due to the clamping of the major vessels, bleeding from the retroperitoneum, longer vascular reconstruction time, and complication of veno-venous bypass have been the shortcomings of CV [ 7 x [7] Khoury, G.F., Mann, M.E., Porot, M.J., Abdul-Rasool, I.H., and Busuttil, R.W. Air embolism associated with veno-venous bypass during orthotopic liver transplantation. Anesthesiology. 1987; 67: 848–851 Crossref | PubMed | Google Scholar See all References , 8 x [8] Reddy, K.S., Johnston, T.D., Putnam, L., Isley, M., and Ranjan, D. Piggyback technique and selective use of veno-venous bypass in adult orthotopic liver transplantation. Clin Transplant. 2000; 14: 370–374 Crossref | PubMed | Google Scholar See all References ]. The piggyback technique (PB) has been used widely in pediatric OLTs as well as OLTs using segmental grafts and living donors. Recently, the advantages of PB have been reported, including lower amount of usage of blood products, shorter operating time, and declining use of veno-venous bypass [ 8 x [8] Reddy, K.S., Johnston, T.D., Putnam, L., Isley, M., and Ranjan, D. Piggyback technique and selective use of veno-venous bypass in adult orthotopic liver transplantation. Clin Transplant. 2000; 14: 370–374 Crossref | PubMed | Google Scholar See all References , 9 x [9] Cherqui, D., Lauzet, J.Y., Rotman, N., Duvoux, C., Dhumeaux, D., and Julien, M. Orthotopic liver transplantation with preservation of the caval and portal flows. 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