End-to-side caval anastomosis in adult piggyback liver transplantation

• Published in: Clinical transplantation 2006-09, Vol.20 (5), p.609-616
• Main Authors: Polak, Wojciech G., Nemes, Balazs A., Miyamoto, Shungo, Peeters, Paul M.J.G, De Jong, Koert P., Porte, Robert J, Slooff, Maarten J.H.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anastomosis, Surgical - methods; Biological and medical sciences; caval anastomosis; complications; Erythrocyte Transfusion; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Survival; Humans; liver transplantation; Liver Transplantation - methods; Medical sciences; Middle Aged; outcome; piggyback; Portacaval Shunt, Surgical; Postoperative Complications; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; surgical technique; Tissue, organ and graft immunology; Treatment Outcome; Vena Cava, Inferior - surgery
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2006.00525.x

:  No consensus exists regarding the optimal reconstruction of the cavo‐caval anastomosis in piggyback orthotopic liver transplantation (PB‐LT). The aim of this study was to analyze our experience with end‐to‐side (ES) cavo‐cavostomy. Outcome parameters were patient and graft survival and surgical complications. During the period 1995–2002 146 full‐size PB‐LT in 137 adult patients were performed with ES cavo‐cavostomy without the routine use of temporary portocaval shunt (TPCS). In 12 patients (8%) this technique was used for implantation of second or third grafts. Veno‐venous bypass was not used in any case and TPCS was performed only in eight patients (6%). One‐, three‐ and five‐yr patient and graft survival were 84%, 79% and 75%, and 81%, 74% and 69%, respectively. The median number of intraoperative transfusion of packed red blood cells (RBC) was 2.0 (range 0–33) and 30% of the patients (n = 43) did not require any RBC transfusion. Surgical complications of various types were observed after 49 LT (34%) and none of the complications was specifically related to the technique of ES cavo‐cavostomy. Our experience indicates that PB‐LT with ES cavo‐cavostomy is a safe procedure, can safely be performed without the routine use of a TPCS, has a very low risk of venous outflow obstruction and can also be used effectively during retransplantations.