Piggyback technique and selective use of veno-venous bypass in adult orthotopic liver transplantation

• Published in: Clinical transplantation 2000-08, Vol.14 (4), p.370-374
• Main Authors: Reddy, K Sudhakar, Johnston, Thomas D, Putnam, Lee Ann, Isley, Michael, Ranjan, Dinesh
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Female; Hepatic Veins - surgery; Humans; liver transplantation; Liver Transplantation - methods; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; piggyback technique; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Vascular Surgical Procedures; Vena Cava, Inferior - surgery; veno-venous bypass
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1034/j.1399-0012.2000.14040202.x

Background. The piggyback technique (PT), with preservation of the cava, is being used more frequently in adult orthotopic liver transplantation (OLT). The advantages of PT include hemodynamic stability during the anhepatic phase without a large‐volume fluid infusion and obviating the need for veno‐venous bypass (VVB). At our center, we changed our practice in July 1997 from the standard technique (ST) of OLT with routine use of VVB to PT and selective use of VVB. The purpose of the present study was to analyze the results with the two different practices, ST‐routine VVB versus PT‐selective VVB. 
Methods. Forty OLTs were performed during the period July 1995–July 1997 using ST‐routine VVB (group I) and 36 during August 1997–December 1998 using PT‐selective VVB (group II). The etiology of liver disease was similar in the two groups, with hepatitis C and alcoholic liver disease accounting for half of the patients in each group. The UNOS status, age, sex, and percentage of patients with previous upper abdominal surgery were also similar between the two groups. 
Results. In the PT‐selective VVB era (group II), 34/36 patients (94%) underwent OLT with PT and VVB was used for 8 (22%) patients. The decision to use VVB was elective for 3 patients (fulminant hepatic failure, 2; severe portal hypertension, 1) and urgent for 5 patients (hemodynamic instability during hepatectomy). The intraoperative use of packed red blood cells (PRBC) (mean±SD) was 15±12 units for group I and 9±8 units for group II (p=0.023). Anastomosis time and total operating time (mean±SD) were 91±30 min and 9.5±3.2 h, respectively, for group I patients compared with 52±28 min and 7.6±1.6 h, respectively, for group II patients (p90%) undergoing OLT. With the routine application of the piggyback procedure, the use of VVB has been reduced to 20% of OLTs at our center. The practice of piggyback techniqu