EXPERIENCE WITH THE PIGGYBACK TECHNIQUE WITHOUT CAVAL OCCLUSION IN ADULT ORTHOTOPIC LIVER-TRANSPLANTATION

Background To assess the feasibility and outcome of a piggyback techni que without caval occlusion or veno-venous bypass (VB), we retrospecti vely reviewed 131 consecutive adult orthotopic liver transplantation ( OLT) performed in 129 patients between May 1993 and February 1995. Six were second transplants, and six were combined liver-kidney transplan ts, The piggyback technique was attempted in all cases. Methods, We we re able to perform the piggyback technique in 98 OLTs (75%), The remai ning 33 OLTs (25%) were converted to the standard technique; of these, 20 (15%) required VB. The reasons for conversion to the standard tech nique were: anatomical (22 transplants), severe portal hypertension re quiring VB (8 transplants), tumor (1 transplant), and other reasons (2 transplants), Six retransplantations were performed (four piggyback, two standard), Results. There was no significant difference in age, Un ited Network for Organ Sharing status, Child's classification, and dia gnosis between the patients in whom piggyback was possible or not, The actuarial patient and graft survival at 1 year were similar between t he piggyback group and the group of patients converted to standard tec hnique (87/85% vs, 86/86%, respectively), No death was related to eith er technique, With piggyback, the average operative time was 8.6+/-1.9 hr, median amount of blood transfused intraoperatively was 2 U (33% d id not require transfusion), and median intensive care unit and hospit al stays were 3 and 11 days, respectively. With the piggyback techniqu e, the mean preoperative and maximum post-operative serum creatinine l evels were 1.4+/-1.0 and 1.8+/-1.5 mg/dl, Conclusion. The piggyback te chnique without caval occlusion is possible in the majority of patient s, It is safe and has reduced the use of VB to 15% of our adult OLTs, The piggyback technique avoids retrocaval dissection, facilitates retr ansplantation, and is associated with a short anhepatic phase, low blo od product usage, and short intensive care unit stay.