PIGGYBACK VERSUS CONVENTIONAL TECHNIQUE IN LIVER-TRANSPLANTATION - REPORT OF A RANDOMIZED TRIAL

Liver transplantation with preservation of the recipient vena cava (th e ''piggy-back'' technique) has been proposed as an alternative to the traditional method. We performed a randomized study on 39 cirrhotic p atients, 20 who underwent the piggy-back technique (group 1) and 19 th e traditional method using venovenous bypass (group 2) to evaluate the feasibility and true advantages of the piggy-back technique compared to the traditional method. Two patients were switched to the conventio nal technique due to the presence of a caudate lobe embracing the vena cava in one patient and a caval lesion in the other. Statistically si gnificant differences between the two groups were only found for the w arm ischemia time (48.5 +/- 13 min for piggy-back vs 60 +/- 12 min for the conventional method) and for renal failure (zero cases in group 1 vs four cases in group 2). We therefore believe that liver transplant ation with the piggy-back technique can easily be performed in almost all cases, and that only a few, specific situations, such as a very en larged caudate lobe. do not justify its routine use.