A comparative study of the classic and piggyback techniques for orthotopic liver transplantation

Authors

  • Mohammad Naser Toutouni Unit of Visceral Transplantation, Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Keywords:

classic technique, venovenous bypass, liver transplantation, piggyback technique

Abstract

Introduction: The classic technique of hepatectomy with venovenous bypass may cause a longer anhepatic phase and increase the rate of some complications, such as post-operative renal failure and thromboembolic events. But, in some cases, such as tumors and anatomic difficulties, the surgeon is obligated to use the classic technique even though there is some controversy about the safety of this technique without venovenous bypass in liver transplantation. The aim of this study was to compare the results of using the classic technique without venovenous bypass and the piggyback technique for liver transplantation. 

Methods: A retrospective case-series study was conducted on 227 consecutive successful liver transplants, including 55 cases in which the classic technique was used and 172 cases in which the piggyback technique was used. The transplants were performed from March 2010 through June 2011 in the Visceral Transplantation Ward at Namazi Hospital in Shiraz, Iran. The piggyback method was the preferred approach for hepatectomy, but the classic technique without venovenous bypass was performed in cirrhotic cases with anatomic difficulties, when there was a tumor, or when the surgeon preferred it.   

Results: There were no significant differences in post-operative rise in creatinine, decreases in intraoperative blood pressure, transfused packed red blood cells (RBC), or survival rates between the groups. Warm ischemic time (duration that donor liver is out of ice until it’s blood reperfusion in the recipient) was approximately seven minutes longer in the classic group (P = 0), but it was less than 52 minutes, which is an acceptable time for this phase.  Hospital stays were shorter in the classic group than in the piggyback group (P = 0.024). 

Conclusion: Although the piggyback technique is the preferred technique for hepatectomy in liver transplantation, the classic technique without venovenous bypass can be used safely in cirrhotic livers when necessary or if the physician prefers it 

References

Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. HOMOTRANSPLANTATION OF THE LIVER IN HUMANS. Surg Gynecol Obstet. 1963;117:659–76. [PMC free article] [PubMed] [Google Scholar]

Starzl TE, Groth CG, Brettschneider L, Penn I, Fulginiti VA, Moon JB, et al. Orthotopic homotransplantation of the human liver. Ann Surg. 1968;168:392–415. [PMC free article] [PubMed] [Google Scholar]

Calne RY, Williams R. Liver transplantation in man. I. Observations on technique and organization in five cases. Br Med J. 1968;4:535–40. [PMC free article] [PubMed] [Google Scholar]

Nikeghbalian S, Dehghani M, Salahi H, Bahador A, Kazemi K, Kakaei F, et al. Effects of surgical technique on postoperative renal function after orthotopic liver transplant. Exp Clin Transplant. 2009;7:25–7. [PubMed] [Google Scholar]

Stieber AC. One surgeon’s experience with the piggyback versus the standard technique in orthotopic liver transplantation: is one better than the other? Hepatogastroenterology. 1995;42:403–5. [PubMed] [Google Scholar]

Busque S, Esquivel CO, Concepcion W, So SK. Experience with the piggyback technique without caval occlusion in adult orthotopic liver transplantation. Transplantation. 1998;65:77–82. [PubMed] [Google Scholar]

Remiszewski P, Zieniewicz K, Krawczyk M. Early results of orthotopic liver transplantations using the technique of inferior vena cava anastomosis. Transplant Proc. 2006;38:237–9. [PubMed] [Google Scholar]

Hosein Shokouh-Amiri M, Osama Gaber A, Bagous WA, Grewal HP, Hathaway DK, Vera SR, et al. Choice of surgical technique influences perioperative outcomes in liver transplantation. Ann Surg. 2000;231:814–23. [PMC free article] [PubMed] [Google Scholar]

Hoffmann K, Weigand MA, Hillebrand N, Buchler MW, Schmidt J, Schemmer P. Is veno-venous bypass still needed during liver transplantation? A review of the literature. Clin Transplant. 2009;23:1–8. [PubMed] [Google Scholar]

Jovine E, Mazziotti A, Grazi GL, Ercolani G, Masetti M, Morganti M, et al. Piggy-back versus conventional technique in liver transplantation: report of a randomized trial. Transpl Int. 1997;10:109–12. [PubMed] [Google Scholar]

Cabezuelo JB, Ramirez P, Acosta F, Torres D, Sansano T, Pons JA, et al. Does the standard vs piggyback surgical technique affect the development of early acute renal failure after orthotopic liver transplantation? Transplant Proc. 2003;35:1913–4. [PubMed] [Google Scholar]

Khan S, Silva MA, Tan YM, John A, Gunson B, Buckels JA, et al. Conventional versus piggyback technique of caval implantation; without extra-corporeal veno-venous bypass. A comparative study. Transpl Int. 2006;19:795–801. [PubMed] [Google Scholar]

Salizzoni M, Andorno E, Bossuto E, Cerutti E, Livigni S, Lupo F, et al. Piggyback techniques versus classical technique in orthotopic liver transplantation: a review of 75 cases. Transplant Proc. 1994;26:3552–3. [PubMed] [Google Scholar]

Miyamoto S, Polak WG, Geuken E, Peeters PM, de Jong KP, Porte RJ, et al. Liver transplantation with preservation of the inferior vena cava. A comparison of conventional and piggyback techniques in adults. Clin Transplant. 2004;18:686–93. [PubMed] [Google Scholar]

Reddy KS, Johnston TD, Putnam LA, Isley M, Ranjan D. Piggyback technique and selective use of veno-venous bypass in adult orthotopic liver transplantation. Clin Transplant. 2000;14:370–4. [PubMed] [Google Scholar]

Vieira de Melo PS, Miranda LE, Batista LL, Neto OC, Amorim AG, Sabat BD, et al. Orthotopic liver transplantation without venovenous bypass using the conventional and piggyback techniques. Transplant Proc. 2011;43:1327–33. [PubMed] [Google Scholar]

Isern MR, Massarollo PC, de Carvalho EM, Baia CE, Kavakama J, de Andrade Lima P, et al. Randomized trial comparing pulmonary alterations after conventional with venovenous bypass versus piggyback liver transplantation. Liver Transpl. 2004;10:425–33. [PubMed] [Google Scholar]

Nishida S, Nakamura N, Vaidya A, Levi DM, Kato T, Nery JR, et al. Piggyback technique in adult orthotopic liver transplantation: an analysis of 1067 liver transplants at a single center. HPB (Oxford) 2006;8:182–8. [PMC free article] [PubMed] [Google Scholar]

Published

2021-12-24