Analysis of the complications of the piggy-back technique in 1,112 liver transplants

Background The "piggy-back" technique has gained acceptance in adult orthot opic liver transplantation during the last few years, especially in Europea n countries, At the moment, however, there is controversy over advantages o r specific complications (suprahepatic thrombosis or narrowing, etc.) relat ed to this surgical technique. The aim of this study is to know of the imme diate per-and postoperative morbidity and mortality rates in 1112 orthotopi c Liver trans plantations performed with a vena cava preservation technique . Methods. All liver transplant units in Spain were sent a questionnaire on retrohepatic vena cava preservation during orthotopic liver transplantatio n. The number of orthotopic liver transplantations that had been performed in the seven centers that answered the questionnaire, because the beginning of the program, was 1674, with the vena cava preservation technique used i n 1112, Results. Twenty-eight patients (2.5%) had intraoperative complicati ons related to the vena cava preservation technique, which were treated dur ing the operation. Eleven patients (1%) had early postoperative complicatio ns (first meek), the most frequent (nine cases) being an acute Budd-Chiari syndrome in the first 48 hr, Three patients developed symptoms of massive a scites between 2 and 3 months (late postoperative complications), with pate ncy of the retrohepatic cava verified by cavography. A hemodynamic study re vealed a hyperpressure at the suprahepatic veins, This chronic Budd-Chiari syndrome was controlled in all patients with diuretics. Only six patients ( 0.5%) died as a result of complications related to the "piggy-back" techniq ue. These complications were more frequent when venous reconstruction was d one using two suprahepatic veins than when the three veins were used (P<0.0 01). Conclusions. The vena cava preservation technique can be used routinel y in orthotopic liver transplantation because it is safe and efficient and involves few surgical complications especially if for venous reconstruction we use the patch obtained by joining the three suprahepatic veins.