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

Seigo Nishida, Noboru Nakamura, Anil Vaidya, David M. Levi, Tomoaki Kato, Jose R. Nery, Juan R. Madariaga, Enrique Molina, Phillip Ruiz, Anthony Gyamfi, Andreas G. Tzakis

Research output: Contribution to journalArticle

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Abstract

Background: Orthotopic liver transplantation (OLT) in adult patients has traditionally been performed using conventional caval reconstruction technique (CV) with veno-venous bypass. Recently, the piggyback technique (PB) without veno-venous bypass has begun to be widely used. The aim of this study was to assess the effect of routine use of PB on OLTs in adult patients. Patients and Methods: A retrospective analysis was undertaken of 1067 orthotopic cadaveric whole liver transplantations in adult patients treated between June 1994 and July 2001. PB was used as the routine procedure. Patient demographics, factors including cold ischemia time (CIT), warm ischemia time (WIT), operative time, transfusions, blood loss, and postoperative results were assessed. The effects of clinical factors on graft survival were assessed by univariate and multivariate analyses. Results: In all, 918 transplantations (86%) were performed with PB. Blood transfusion, WIT, and usage of veno-venous bypass were less with PB. Seventy-five (8.3%) cases with PB had refractory ascites following OLT (p = NS). Five venous outflow stenosis cases (0.54%) with PB were noted (p = NS). The liver and renal function during the postoperative periods was similar. Overall 1-, 3-, and 5-year patient survival rates were 85%, 78%, and 72% with PB. Univariate analysis showed that cava reconstruction method, CIT, WIT, amount of transfusion, length of hospital stay, donor age, and tumor presence were significant factors influencing graft survival. Multivariate analysis further reinforced the fact that CIT, donor age, amount of transfusion, and hospital stay were prognostic factors for graft survival. Conclusions: PB can be performed safely in the majority of adult OLTs. Results of OLT with PB are as same as for CV. Liver function, renal function, morbidity, mortality, and patient and graft survival are similar to CV. However, amount of transfusion, WIT, and use of veno-venous bypass are less with PB.

Original languageEnglish
Pages (from-to)182-188
Number of pages7
JournalHPB
Volume8
Issue number3
DOIs
StatePublished - Jun 1 2006

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Liver Transplantation
Warm Ischemia
Transplants
Graft Survival
Liver
Cold Ischemia
Length of Stay
Multivariate Analysis
Tissue Donors
Kidney
Postoperative Hemorrhage
Venae Cavae
Operative Time
Ascites
Postoperative Period
Blood Transfusion
Pathologic Constriction
Survival Rate
Transplantation
Demography

Keywords

  • Complication
  • Liver transplantation
  • Piggyback technique

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Nishida, S., Nakamura, N., Vaidya, A., Levi, D. M., Kato, T., Nery, J. R., ... Tzakis, A. G. (2006). Piggyback technique in adult orthotopic liver transplantation: An analysis of 1067 liver transplants at a single center. HPB, 8(3), 182-188. https://doi.org/10.1080/13651820500542135

Piggyback technique in adult orthotopic liver transplantation : An analysis of 1067 liver transplants at a single center. / Nishida, Seigo; Nakamura, Noboru; Vaidya, Anil; Levi, David M.; Kato, Tomoaki; Nery, Jose R.; Madariaga, Juan R.; Molina, Enrique; Ruiz, Phillip; Gyamfi, Anthony; Tzakis, Andreas G.

In: HPB, Vol. 8, No. 3, 01.06.2006, p. 182-188.

Research output: Contribution to journalArticle

Nishida, S, Nakamura, N, Vaidya, A, Levi, DM, Kato, T, Nery, JR, Madariaga, JR, Molina, E, Ruiz, P, Gyamfi, A & Tzakis, AG 2006, 'Piggyback technique in adult orthotopic liver transplantation: An analysis of 1067 liver transplants at a single center', HPB, vol. 8, no. 3, pp. 182-188. https://doi.org/10.1080/13651820500542135
Nishida, Seigo ; Nakamura, Noboru ; Vaidya, Anil ; Levi, David M. ; Kato, Tomoaki ; Nery, Jose R. ; Madariaga, Juan R. ; Molina, Enrique ; Ruiz, Phillip ; Gyamfi, Anthony ; Tzakis, Andreas G. / Piggyback technique in adult orthotopic liver transplantation : An analysis of 1067 liver transplants at a single center. In: HPB. 2006 ; Vol. 8, No. 3. pp. 182-188.
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abstract = "Background: Orthotopic liver transplantation (OLT) in adult patients has traditionally been performed using conventional caval reconstruction technique (CV) with veno-venous bypass. Recently, the piggyback technique (PB) without veno-venous bypass has begun to be widely used. The aim of this study was to assess the effect of routine use of PB on OLTs in adult patients. Patients and Methods: A retrospective analysis was undertaken of 1067 orthotopic cadaveric whole liver transplantations in adult patients treated between June 1994 and July 2001. PB was used as the routine procedure. Patient demographics, factors including cold ischemia time (CIT), warm ischemia time (WIT), operative time, transfusions, blood loss, and postoperative results were assessed. The effects of clinical factors on graft survival were assessed by univariate and multivariate analyses. Results: In all, 918 transplantations (86{\%}) were performed with PB. Blood transfusion, WIT, and usage of veno-venous bypass were less with PB. Seventy-five (8.3{\%}) cases with PB had refractory ascites following OLT (p = NS). Five venous outflow stenosis cases (0.54{\%}) with PB were noted (p = NS). The liver and renal function during the postoperative periods was similar. Overall 1-, 3-, and 5-year patient survival rates were 85{\%}, 78{\%}, and 72{\%} with PB. Univariate analysis showed that cava reconstruction method, CIT, WIT, amount of transfusion, length of hospital stay, donor age, and tumor presence were significant factors influencing graft survival. Multivariate analysis further reinforced the fact that CIT, donor age, amount of transfusion, and hospital stay were prognostic factors for graft survival. Conclusions: PB can be performed safely in the majority of adult OLTs. Results of OLT with PB are as same as for CV. Liver function, renal function, morbidity, mortality, and patient and graft survival are similar to CV. However, amount of transfusion, WIT, and use of veno-venous bypass are less with PB.",
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T1 - Piggyback technique in adult orthotopic liver transplantation

T2 - An analysis of 1067 liver transplants at a single center

AU - Nishida, Seigo

AU - Nakamura, Noboru

AU - Vaidya, Anil

AU - Levi, David M.

AU - Kato, Tomoaki

AU - Nery, Jose R.

AU - Madariaga, Juan R.

AU - Molina, Enrique

AU - Ruiz, Phillip

AU - Gyamfi, Anthony

AU - Tzakis, Andreas G.

PY - 2006/6/1

Y1 - 2006/6/1

N2 - Background: Orthotopic liver transplantation (OLT) in adult patients has traditionally been performed using conventional caval reconstruction technique (CV) with veno-venous bypass. Recently, the piggyback technique (PB) without veno-venous bypass has begun to be widely used. The aim of this study was to assess the effect of routine use of PB on OLTs in adult patients. Patients and Methods: A retrospective analysis was undertaken of 1067 orthotopic cadaveric whole liver transplantations in adult patients treated between June 1994 and July 2001. PB was used as the routine procedure. Patient demographics, factors including cold ischemia time (CIT), warm ischemia time (WIT), operative time, transfusions, blood loss, and postoperative results were assessed. The effects of clinical factors on graft survival were assessed by univariate and multivariate analyses. Results: In all, 918 transplantations (86%) were performed with PB. Blood transfusion, WIT, and usage of veno-venous bypass were less with PB. Seventy-five (8.3%) cases with PB had refractory ascites following OLT (p = NS). Five venous outflow stenosis cases (0.54%) with PB were noted (p = NS). The liver and renal function during the postoperative periods was similar. Overall 1-, 3-, and 5-year patient survival rates were 85%, 78%, and 72% with PB. Univariate analysis showed that cava reconstruction method, CIT, WIT, amount of transfusion, length of hospital stay, donor age, and tumor presence were significant factors influencing graft survival. Multivariate analysis further reinforced the fact that CIT, donor age, amount of transfusion, and hospital stay were prognostic factors for graft survival. Conclusions: PB can be performed safely in the majority of adult OLTs. Results of OLT with PB are as same as for CV. Liver function, renal function, morbidity, mortality, and patient and graft survival are similar to CV. However, amount of transfusion, WIT, and use of veno-venous bypass are less with PB.

AB - Background: Orthotopic liver transplantation (OLT) in adult patients has traditionally been performed using conventional caval reconstruction technique (CV) with veno-venous bypass. Recently, the piggyback technique (PB) without veno-venous bypass has begun to be widely used. The aim of this study was to assess the effect of routine use of PB on OLTs in adult patients. Patients and Methods: A retrospective analysis was undertaken of 1067 orthotopic cadaveric whole liver transplantations in adult patients treated between June 1994 and July 2001. PB was used as the routine procedure. Patient demographics, factors including cold ischemia time (CIT), warm ischemia time (WIT), operative time, transfusions, blood loss, and postoperative results were assessed. The effects of clinical factors on graft survival were assessed by univariate and multivariate analyses. Results: In all, 918 transplantations (86%) were performed with PB. Blood transfusion, WIT, and usage of veno-venous bypass were less with PB. Seventy-five (8.3%) cases with PB had refractory ascites following OLT (p = NS). Five venous outflow stenosis cases (0.54%) with PB were noted (p = NS). The liver and renal function during the postoperative periods was similar. Overall 1-, 3-, and 5-year patient survival rates were 85%, 78%, and 72% with PB. Univariate analysis showed that cava reconstruction method, CIT, WIT, amount of transfusion, length of hospital stay, donor age, and tumor presence were significant factors influencing graft survival. Multivariate analysis further reinforced the fact that CIT, donor age, amount of transfusion, and hospital stay were prognostic factors for graft survival. Conclusions: PB can be performed safely in the majority of adult OLTs. Results of OLT with PB are as same as for CV. Liver function, renal function, morbidity, mortality, and patient and graft survival are similar to CV. However, amount of transfusion, WIT, and use of veno-venous bypass are less with PB.

KW - Complication

KW - Liver transplantation

KW - Piggyback technique

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