Comparison of surgical methods in liver transplantation: retrohepatic caval resection with venovenous bypass (VVB) versus piggyback (PB) with VVB versus PB without VVB.

Abstract	Use of piggyback technique (PB) and elimination of venovenous bypass (VVB) have been advocated in adult liver transplantation (LT). However, individual contribution of these two modifications on clinical outcomes has not been fully investigated. We performed a retrospective review of 426 LTs within a 3-year period, when three different surgical techniques were employed per the surgeons' preference: retrohepatic caval resection with VVB (RCR+VVB) in 104 patients, PB with VVB (PB+VVB) in 148, and PB without VVB (PB-Only) in 174. The primary outcomes were intraoperative blood transfusion and the patient and graft survivals. Demographic profiles were similar, except younger recipient age in RCR+VVB and fewer number of grafts with cold ischemic time over 16 h in PB-Only. PB-Only required lesser intraoperative red blood cells (P=0.006), fresh frozen plasma (P=0.005), and cell saver return (P=0.007); had less incidence of acute renal failure (P=0.001), better patient survival (P=0.039), and graft survival (P=0.003). The benefits of PB+VVB were only found in shortened total surgical time (P=0.0001) and warm ischemic time (P=0.0001), and less incidence of acute renal failure (P=0.001) than RCR+VVB. PB-Only method seemed to provide the best clinical outcome. The benefit of PB was not fully achieved when it was used with VVB.
Authors	Tetsuro Sakai, Takashi Matsusaki, James W Marsh, Ibtesam A Hilmi, Raymond M Planinsic
Journal	Transplant international : official journal of the European Society for Organ Transplantation (Transpl Int) Vol. 23 Issue 12 Pg. 1247-58 (Dec 2010) ISSN: 1432-2277 [Electronic] Switzerland
PMID	20723178 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
Copyright	© 2010 The Authors. Journal compilation © 2010 European Society for Organ Transplantation.
Topics	Adult Aged Extracorporeal Circulation (methods) Female Graft Survival Humans Intraoperative Period Liver Transplantation (methods, mortality) Male Middle Aged Retrospective Studies Treatment Outcome Vena Cava, Inferior (surgery)

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